Original Article
Clinical effects and safety of catheter- directed thrombolysis for acute lower extremity deep vein thrombosis in patients aged 70 years and over
Qianyi Chen, Hua Wang, Xiaoman Hu, Zhewei Fei, Jingmin Ou
Published 2016-02-14
Cite as Chin J Geriatr, 2016, 35(2): 133-136. DOI: 10.3760/cma.j.issn.0254-9026.2016.02.005
Abstract
ObjectiveTo analyze the efficacy and safety of catheter-directed thrombolysis (CDT) for acute lower extremity deep venous thrombosis (DVT) in patients aged 70 years and over .
MethodsClinical data of 109 cases who had acute lower extremity DVT and had been treated with CDT from March 2011 to September 2014 were retrospectively analyzed.
ResultsInferior vena cava filters (IVCF) were implanted in 109 patients. A thrombolytic catheter was inserted from the contralateral femoral vein (21 cases), ipsilateral popliteal vein (44 cases), posterior tibial vein (28 cases) or small saphenous vein (16 cases). The duration of thrombolysis was (5.47±2.13) d. The dosage of urokinase was (3.80±0.56)million units. Forty-two cases underwent balloon dilatation alone, and 67 cases combined balloon dilatation with stent implantation. Gingival bleeding occurred in 7 patients and gross hematuria occurred in 4 patients during thrombolysis, which disappeared after medication adjustment. No symptomatic pulmonary embolism (PE) or other serious complications were found in any patients. There were significant differences in the venous patency score and lower limb circumferences at 10 cm above and below the knee one week after treatment (t=3.874, P=0.031). Ninety-seven cases were followed up for a mean period of (20.7±6.5) months, and the vein patency rate was (77.9±10.5) % and (73.1±9.4) % at 6 and 18 months after treatment, respectively. Recurrence of deep vein thrombosis was found in 6 cases, of which 2 cases had recurrent stent thrombosis, and treatment with CDT again was successful. No severe deep venous thrombosis syndrome (PTS) was found during the follow-up.
ConclusionsCDT is a minimally invasive procedure and can rapidly resolve limb venous drainage disorders. CDT is safe, has few complications and usually generates satisfactory outcomes. For very-old elderly patients who have no anticoagulation and thrombolytic contraindications, CDT is a useful option for the treatment of acute lower limb DVT.
Key words:
Venous thrombosis; Catheterization, peripheral; Thrombolytic therapy
Contributor Information
Qianyi Chen
Department of General Surgery, Chongming Branch of Affiliated Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 202150, China
Hua Wang
Department of General Surgery, Chongming Branch of Affiliated Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 202150, China
Xiaoman Hu
Department of General Surgery, Affiliated Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
Zhewei Fei
Department of General Surgery, Chongming Branch of Affiliated Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 202150, China
Jingmin Ou
Department of General Surgery, Affiliated Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200090, China