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  • Title: Treatment of chronic deep vein thrombosis using ultrasound accelerated catheter-directed thrombolysis.
    Author: Dumantepe M, Tarhan IA, Ozler A.
    Journal: Eur J Vasc Endovasc Surg; 2013 Sep; 46(3):366-71. PubMed ID: 23806796.
    Abstract:
    OBJECTIVE: To evaluate the feasibility, efficacy and safety of ultrasound-accelerated catheter-directed thrombolysis (UACDT) in the delayed treatment of lower extremity deep venous thrombosis (DVT). DESIGN: Twelve patients with unilateral iliofemoral or femoropopliteal DVT (mean symptom duration 92 ± 44 days) were prospectively investigated. METHOD: UACDT was performed using recombinant human tissue plasminogen activator delivered using the EKOS EkoSonic system. Stents were deployed if indicated by post-procedure venography. Follow-up comprised weekly duplex ultrasound for 1 month and monthly thereafter. RESULTS: Successful thrombolysis occurred in 11/12 limbs (92%; complete 6/12, partial 5/12) after a mean infusion time of 26 ± 7 hours. 2/12 patients required angioplasty and stent insertion. At a mean follow-up of 9 (6-15) months, 10/11 (91%) veins were patent whereas 1/11 re-occluded at 2 months (patient with protein-C deficiency). 2/11 limbs developed symptoms/signs of post-thrombotic syndrome and 3/11 had developed deep vein reflux (duplex ultrasound). 2/12 patients experienced peri-catheter bleeding but no major hemorrhage or symptomatic pulmonary embolism occurred. CONCLUSIONS: This preliminary evidence suggests that UACDT may be a safe and effective option for the delayed treatment of lower limb DVT.
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