Interv Akut Kardiol. 2003;2(2):61-68

Our experiences with endovascular treatment of ileofemoral venous thrombosis

Miroslav Chochola¹, Petr Vařejka¹, Simon Jirát¹, Michael Aschermann¹, Jiří Křivánek², Karel Goričan³, Radka Klézlová⁴

¹ II. interní klinika kardiologie a angiologie 1. LF UK a VFN, Praha

² Radiodiagnostická klinika 1. LF UK, oddělení magnetické rezonance, Praha

³ IV. interní klinika VFN a 1. LF UK, Praha

⁴ Interní oddělení ÚVN, Praha

Objective: Goal of our treatment was an evaluation of primary and long-term efficacy of endovascular treatment in patients with ileofemoral venous thrombosis.

Data and methods: We have treated 44 extremities in 38 patients with diagnosis of ileofemoral venous thrombosis with local continuous thrombolysis. Right lower extremity has been treated 8 times (18,2 %) and left lower extremity 36 (81.2 %) times. There were 9 men (24 %) and 29 women (76 %) in the group. Average age was 28,7 years (range 17–66). Average duration of thrombosis was 9,7 (1–21) days. For the treatment of thrombosis rt-PA was used in 40 (88,8 %) extremities and urokinase in 5 (11,2 %) extremities. Average total dose of urokinase was 7.7 (6 – 16.5) million units and average time of thrombolysis duration was 78 (60–110) hours. Average total dose when using rt-PA was 44,86 (20–80) mg and average duration of thrombolysis was 46 (12–72) hours. Among adjuvant techniques, percutaneous transluminal angioplasty was used in the treatment of 30 (68,2 %) extremities, percutaneous mechanical thrombectomy was used in 11 (25 %) extremities. We have implanted 24 stents in 20 (45,4 %) extremities. We have used temporary caval filter in 16 (42,1 %) patients.

Results: Primary success was achieved in the treatment of 37 (84,1 %) extremities. Three month later was 35 (79,5 %) extremities without signs of re-thrombosis in the treated area, six months later 33 (75 %) extremities, twelve months later 31 (70,4 %) extremities, twenty four months later 28 (63,6 %) extremities. All patients with a stent have had treated area clear in 100 % after 12 months. Closure of 1 stent occurred after 24 months. We have experienced 6 (15,7 %) minor and 4 (10,5 %) serous complications during the treatment. Diagnosis of post-thrombotic syndrome or chronic venous insufficiency was stated in 18 (40,9 %) extremities. No patient has undergone pulmonary embolisation nor died.

Conclusion: Results of study present local continuous thrombolysis with combination of percutaneous transluminal angioplasty and stenting as efficient method resulting in passage return of deep venous system and in elimination of acute symptoms in majority of patients with diagnosis of ileofemoral venous thrombosis under condition keeping indication and contraindication criteria.

Keywords: venous thrombosis, local continuous thrombolysis, percutaneous transluminal angioplasty, stent.

Published: December 31, 2003  Show citation