The Influence on the Venous Function of Catheter-Directed Thrombolysis for Deep Vein Thrombosis in Lower Extremity.
- Author:
Jeong Nam KWON
1
;
Dong Eun PARK
;
Kyung Keun LEE
;
Kwon Mook CHAE
;
Kwon Ha YOON
;
Byung Jun SO
Author Information
1. Department of Surgery, Wonkwang University College of Medicine, Iksan, Korea. sobjun@wonnms.wonkwang.ac.kr
- Publication Type:Original Article
- Keywords:
Deep vein thrombosis;
Catheter-directed thrombolysis
- MeSH:
Catheters;
Extremities;
Female;
Follow-Up Studies;
Heparin;
Heparin, Low-Molecular-Weight;
Humans;
Lower Extremity*;
Male;
Phlebography;
Plethysmography;
Residual Volume;
Thrombolytic Therapy;
Ultrasonography;
Urokinase-Type Plasminogen Activator;
Venous Thrombosis*;
Warfarin
- From:Journal of the Korean Society for Vascular Surgery
2001;17(1):79-87
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Having been disappointed with standard anticoagulation therapy for acute deep vein thrombosis (DVT) in lower extremity, we started catheter-directed thrombolytic therapy. And the aim of this study was to evaluate the effects on venous function of catheter-directed thrombolytic therapy by noninvasive venous tests such as Air plethysmography (APG) and duplex ultrasonography. METHOD: 36 patients with DVT of less than 3 weeks after development into two groups according to treatment modality:Group 1; catheter-directed thrombolysis with Urokinase followed by low-molecular weight heparin (LMWH) and coumadin therapy (n=19, men; 11, women; 8, mean age 47.6 years), Group 2; conventional anticoagulation with LMWH followed by coumadin therapy (n=17; men; 12, women; 5, mean age 47.1 years). The results of lytic therapy were examined by complete phlebography on time of removal of catheter. The location and extent of thrombotic changes were followed-up with duplex scan and venous function was examined with APG. RESULT: Complete clot resolution by lytic therapy was obtained in 12 cases out of 19 cases (63.2%) in Group 1. The residual thrombi at follow-up around 1 year were detected in 4 cases in Group 1, in 11 cases in Group 2. APG parameters that were significantly different (P<0.05) between the two groups were the venous filling index:(Group 1; 1.63+/-1.36 ml/sec, Group 2; 2.66+/-1.58 ml/sec), residual volume fraction (Group 1; 27.54+/-17.40%, Group 2; 49.19+/-20.45%) and outflow fraction (Group 1; 37.79+/-7.05%, Group 2; 32.36+/-6.31 %). The parameters of APG and ultrasonography in Group 1 revealed lesser degree of reflux and smaller amount of residual thrombi. CONCLUSION: Catheter-directed thrombolytic therapy shows better results in complete resolution rate of the acute DVT, reducing remnant thrombi, and preserving venous function such as venous filling index, residual volume fraction and outflow fraction. APG and duplex scanning seem to be useful methods for a complete follow-up evaluation of limbs with DVT.
