8:27 AM Abstract No. 23 - Same day endovascular therapy for lower extremity deep venous thrombosis: technique and initial results

Abstract

Treatment of deep venous thrombosis(DVT) using catheter-directed thrombolysis (CDT) has been limited by long procedure time and associated high costs, high doses of thrombolytics, and increased utilization of intensive ICU monitoring. The purpose of this study is to describe a single center technique of same day pharmacomechanical catheter-directed thrombolysis (PCDT) for lower extremity DVT. A single center retrospective review was performed on 39 consecutive patients (25 males and 14 females; mean age 51; range 18-84) treated with PDCT in a single day without ICU admission. Technique included power pulse spray with Angioget (Bayer Healthcare, Warrendale, PA) thrombectomy followed by short duration CDT and second session venoplasty and stenting. All patients received at least 6 months of anticoagulation and graded compression stockings post procedure. Data collected included: patient demographics, procedural technical success (defined as 1- the ability to successfully cross the occlusion and 2- restoration of flow to the IVC), major and minor adverse events up to 30 days, freedom from reintervention (FFR) as well as 1 and 6 month follow-up with ultrasound or clinical examination. 15 patients with acute DVT (<14 days), 8 patients with subacute DVT (14-28 days) and 17 patients with chronic DVT (>28 days) were treated. DVT location included: iliocaval (n=10), iliofemoral (n=23) and femoropopliteal (n=6). Technical success was achieved in all cases. FFR was 76%. Reintervention was successfully performed in 10/10 patients (100%). One and six month follow-up was obtained for 32/39 patients (82%) with 72% (23/32) and 56% (18/32) patency at 1 and 6 months, respectively. Adverse events were noted in 5 patients (13%) including breast hematoma, groin hematoma, rapid atrial fibrillation, contrast-induced nephropathy, and death (unrelated to the procedure). Same day PDCT without ICU admission for lower extremity DVT is feasible with high technical success and FFR. Adverse events are rare. Further studies are needed to demonstrate long-term vessel patency as well as reduction in the incidence of post-thrombotic syndrome.