Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지

Endovascular Treatment of Left Iliofemoral Deep Vein Thrombosis Using Urokinase Thrombolysis and Adjunctive Aspiration Thrombectomy

유로키나제 혈전용해술과 카테터를 이용한 혈전흡입술을 함께 시행한 좌측 하지 심부정맥혈전증의 치료

  • Suh, Sang-Hyun (Department of Radiology, Gangnam Severance Hospital, Severance Institute of Vascular and Metabolic Research, Yonsei University College of Medicine) ;
  • Lee, Do-Yun (Department of Radiology, Severance Hospital, Yonsei University) ;
  • Won, Jong-Yun (Department of Radiology, Gangnam Severance Hospital, Severance Institute of Vascular and Metabolic Research, Yonsei University College of Medicine)
  • 서상현 (연세대학교 강남세브란스병원 영상의학과, 연세대학교 혈관대사연구소) ;
  • 이도연 (연세대학교 세브란스병원 영상의학과) ;
  • 원종윤 (연세대학교 강남세브란스병원 영상의학과, 연세대학교 혈관대사연구소)
  • Received : 2009.11.24
  • Accepted : 2010.04.20
  • Published : 2010.07.01
⟨ Previous Next ⟩

Abstract

Purpose: To evaluate the efficacy of adjunctive aspiration thrombectomy for the treatment of iliofemoral deep vein thrombosis (DVT). Materials and Methods: 24 patients (9 males and 15 females; mean age, 53 years), treated by aspiration thrombectomy were enrolled in this study. The day after undergoing urokinase (UK) thrombolysis, any residual thrombus over a long segment was treated by aspiration thrombectomy using a 12 Fr long sheath. Residual short-segment (< 10 cm) iliac vein thrombus and/or stenosis were treated with a stent. The evaluation of venous patency was conducted by color Doppler ultrasonography, venography and/or computed tomography. Results: The technical and clinical success rates were 100% and 92%, respectively. Twenty-three patients were treated by UK thrombolysis and iliac stent. The overall patency rate at 1, 2 and 3 years was 85%, 82% and 81%, respectively. Over the course of the follow-up period, occlusion was observed in 4 cases (1 acute and 3 chronic cases). Periprocedural complication occurred in 4 cases (17%) in the form of a minimal hematoma or pain on the puncture site as well as a case of pulmonary embolism at one month after treatment. Conclusion: The adjunctive aspiration thrombectomy with conventional thrombolysis and stent placement can be an effective and safe method in the treatment of left iliofemoral DVT.

목적: 좌측 하지 심부정맥혈전증의 치료에 있어서 유로키나아제를 이용한 혈전용해술에서 시행한 카테터를 이용한 혈전 흡입술의 유용성 및 그 치료 결과에 대하여 알아보는 것이다. 대상과 방법: 2000년 1월부터 2004년 7월까지 혈전흡입술을 시행한 24명을 대상으로 하였다. 초음파 유도 하에 동측의 슬와정맥을 천자하여 카테터를 통하여 유로키나아제를 주입하였고, 다음날 정맥 촬영결과에 따라 혈전이 부분적으로 용해되고 혈류의 흐름이 적은 경우는 남은 혈전은 굵은 구경(12Fr)을 가진 카테터를 이용한 혈전흡입술을 시행하였으며, 이후 남은 혈전 및 정맥의 협착부위에 대하여 혈관성형술과 스텐트 삽입을 시도하였다. 시술 후 정맥 개통 여부를 확인하기 위하여 정맥혈관조영술, 색도플러초음파 혹은 전산화단층촬영술 추적검사를 하였다. 결과: 기술적 및 임상적 성공률은 각각 100%, 92%이며 혈전용해술 및 스텐트 삽입을 시행한 환자는 각각 23명이었고, 1명은 혈전흡입술만 시행하였다. 추적기간 에 전체 정맥 혈관 개통률은 1년 85%, 2년 82%, 3년 81%이었다. 추적검사기간 에 혈관의 폐색은 급성 1예, 만성 3예가 있었다. 시술 후 합병증은 추적 검사기간에 발생한 1예의 폐동맥 색전증이 있었다. 결론: 하지 심부정맥혈전증의 치료에 있어서 기존의 유로키나아제를 이용한 혈전용해술과 스텐트 삽입술에 병행하여 시행한 카테터를 이용한 혈전흡입술은 효과적이고 안전한 방법으로 생각된다.

Keywords

References

  1. Nordstrom M, Lindblad B, Bergqvist D, Kjellstrom T. A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med 1992;232:155-160 https://doi.org/10.1111/j.1365-2796.1992.tb00565.x
  2. Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med 1991;151:933-938 https://doi.org/10.1001/archinte.151.5.933
  3. O'Donnell TF Jr, Browse NL, Burnand KG, Thomas ML. The socioeconomic effects of an iliofemoral venous thrombosis. J Surg Res 1977;22:483-488 https://doi.org/10.1016/0022-4804(77)90030-0
  4. Krupski WC, Bass A, Dilley RB, Bernstein EF, Otis SM. Propagation of deep venous thrombosis identified by duplex ultrasonography. J Vasc Surg 1990;12:467-474 https://doi.org/10.1016/0741-5214(90)90049-G
  5. Kearon C, Hirsh J. Management of anticoagulation before and after elective surgery. N Engl J Med 1997;336:1506-1511 https://doi.org/10.1056/NEJM199705223362107
  6. Gonzalez-Fajardo JA, Arreba E, Castrodeza J, Perez JL, Fernancez L, Agundez I, et al. Venographic comparison of subcutaneous lowmolecular weight heparin with oral anticoagulant therapy in the long-term treatment of deep venous thrombosis. J Vasc Surg 1999;30:283-292 https://doi.org/10.1016/S0741-5214(99)70139-4
  7. Comerota AJ, Aldridge SC. Thrombolytic therapy for deep venous thrombosis: a clinical review. Can J Surg 1993;36:359-364
  8. McNamara TO, Fischer JR. Thrombolysis of peripheral arterial and graft occlusions: improved results using high-dose urokinase. AJR Am J Roentgenol 1985;144:769-775 https://doi.org/10.2214/ajr.144.4.769
  9. Semba CP, Dake MD. Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis. Radiology 1994;191:487-494
  10. Becker GJ, Holden RW, Rabe FE, Castaneda-Zuniga WR, Sears N, Dilley RS, et al. Local thrombolytic therapy for subclavian and axillary vein thrombosis. Treatment of the thoracic inlet syndrome. Radiology 1983;149:419-423 https://doi.org/10.1148/radiology.149.2.6622685
  11. Grossman C, McPherson S. Safety and efficacy of catheter-directed thrombolysis for iliofemoral venous thrombosis. AJR Am J Roentgenol 1999;172:667-672 https://doi.org/10.2214/ajr.172.3.10063857
  12. Comerota AJ. Quality-of-life improvement using thrombolytic therapy for iliofemoral deep venous thrombosis. Rev Cardiovasc Med 2002;3 Suppl 2:S61-S67
  13. Verhaeghe R, Stockx L, Lacroix H, Vermylen J, Baert AL. Catheterdirected lysis of iliofemoral vein thrombosis with use of rt-PA. Eur Radiol 1997;7:996-1001 https://doi.org/10.1007/s003300050239
  14. Vedantham S, Vesely TM, Parti N, Darcy M, Hovsepian DM, Picus D. Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy. J Vasc Interv Radiol 2002;13:1001-1008 https://doi.org/10.1016/S1051-0443(07)61864-8
  15. Vedantham S, Vesely TM, Sicard GA, Brown D, Rubin B, Sanchez LA, et al. Pharmacomechanical thrombolysis and early stent placement for iliofemoral deep vein thrombosis. J Vasc Interv Radiol 2004;15:565-574 https://doi.org/10.1097/01.RVI.0000127894.00553.02
  16. Frisoli JK, Sze D. Mechanical thrombectomy for the treatment of lower extremity deep vein thrombosis. Tech Vasc Interv Radiol 2003;6:49-52 https://doi.org/10.1053/tvir.2003.36439
  17. Ramaiah V, Del Santo PB, Rodriguez-Lopez JA, Gowda RG, Perkowski PE, Diethrich EB. Trellis thrombectomy system for the treatment of iliofemoral deep venous thrombosis. J Endovasc Ther 2003;10:585-589 https://doi.org/10.1583/1545-1550(2003)010<0585:TTSFTT>2.0.CO;2
  18. Augustinos P, Ouriel K. Invasive approaches to treatment of venous thromboembolism. Circulation 2004;110(9 Suppl 1) :I27-I34 https://doi.org/10.1161/01.CIR.0000140900.64198.f4
  19. Hood DB, Alexander JQ. Endovascular management of iliofemoral venous occlusive disease. Surg Clin North Am 2004;84:1381-1396 https://doi.org/10.1016/j.suc.2004.06.002
  20. May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology 1957;8:419-427 https://doi.org/10.1177/000331975700800505
  21. Berger A, Jaffe JW, York TN. Iliac compression syndrome treated with stent placement. J Vasc Surg 1995;21:510-514 https://doi.org/10.1016/S0741-5214(95)70295-4
  22. Bjarnason H, Kruse JR, Asinger DA, Nazarian GK, Dietz CA, Caldwell MD, et al. Iliofemoral deep venous thrombosis: safety and efficacy outcome during 5 years of catheter-directed thrombolytic therapy. J Vasc Interv Radiol 1997;8:405-418 https://doi.org/10.1016/S1051-0443(97)70581-5
  23. Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology 1999;211:39-49
  24. Johnson BF, Manzo RA, Bergelin RO, Strandness DE Jr. Relationship between changes in the deep venous system and the development of the postthrombotic syndrome after an acute episode of lower limb deep vein thrombosis: a one- to six-year follow- up. J Vasc Surg 1995;21:307-312 https://doi.org/10.1016/S0741-5214(95)70271-7
  25. Chang R, Cannon RO 3rd, Chen CC, Doppman JL, Shawker TH, Mayo DJ, et al. Daily catheter-directed single dosing of t-PA in treatment of acute deep venous thrombosis of the lower extremity. J Vasc Interv Radiol 2001;12:247-252 https://doi.org/10.1016/S1051-0443(07)61832-6
  26. Uflacker R. Mechanical thrombectomy in acute and subacute thrombosis with use of the Amplatz device: arterial and venous applications. J Vasc Interv Radiol 1997;8:923-932 https://doi.org/10.1016/S1051-0443(97)70688-2
  27. Kasirajan K, Gray B, Ouriel K. Percutaneous angioJet thrombectomy in the management of extensive deep venous thrombosis. J Vasc Interv Radiol 2001;12:179-185 https://doi.org/10.1016/S1051-0443(07)61823-5