Abstract
Four patients with extensive acute iliofemoral and popliteal vein thrombosis and partially extending into the inferior venacava (IVC) with diffuse swelling of lower limb and gluteal region were studied. Initially, Gunther Tulip (Cook) IVC filter was placed in all patients. A 5F multipurpose catheter with side holes was placed in common iliac vein bifurcation and thrombolysis was done for 18 hours with diluted streptokinase infusion at 50,000 U/hr. Thereafter, a 5 mm × 4 cm peripheral balloon was advanced through the clots to mid or lower femoral vein level and thrombolysis was done for 18 hours with streptokinase infusion through the balloon’s 035 wire port. The balloon was pulled back and multiple serial dilatations were done in all four procedures. Post procedure the venous channels were opened and were draining adequately. Limb edema subsided in 4 to 5 days and there were no bleeding or embolic complications in all patients. The first two patients are on follow up for 18 months, the third patient for 5 months, and the fourth patient for 2 weeks. Based on these observations, two novel balloon models for thrombolysis and to perform venous angioplasty simultaneously were developed. The piggyback model has a side lumen catheter with side holes attached to the shaft of the balloon catheter (5 mm width × 4 cm length ). The side lumen terminates before the balloon. The horseshoe models made of polyethylene terephthalate have a 10 cm long and 4 mm wide compliant balloon with a double lumen catheter and multiple side ports till the balloon tip.
Highlights
Venous thromboembolism (VTE) is a common clinical problem and occurs in about 350 000 to 600 000 persons per year in the United States alone, of which approximately 50% are first episodes of deep vein thrombosis (DVT) [1]
We investigated the potential role of balloon directed thrombolysis as well as the safety and efficacy of such procedure
The study outlines a novel method of treatment of DVT by direct thrombolysis through the balloon as well as venous angioplasty simultaneously
Summary
Venous thromboembolism (VTE) is a common clinical problem and occurs in about 350 000 to 600 000 persons per year in the United States alone, of which approximately 50% are first episodes of deep vein thrombosis (DVT) [1]. We investigated the potential role of balloon directed thrombolysis as well as the safety and efficacy of such procedure. The second patient who was a 48 yr old lady, stopped anticoagulation medications and presented with ilio-femoral thrombosis in the contralateral limb on follow-up. Post thrombolysis IVC angiogram showed mild recanalization of left common iliac veins leaving a stump.
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