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- W2054151036 abstract "Catheter-directed thrombolysis and pharmaco-mechanical thrombectomy (PMT) are increasingly used to resolve current symptoms and possibly reduce future postthrombotic syndrome (PTS) in deep venous thrombosis. Venographic control remains the basic technique used in most institutions with these procedures. Residual thrombosis is likely the key to residual symptoms, recurrent thrombosis, and the development of PTS. We present our experience with intravascular ultrasound (IVUS) use along with venography for aiding lytic procedures to highlight the superiority of IVUS in assessing residual thrombus. A total of 65 limbs underwent PMT (Trellis) for deep venous thrombosis involving the iliac-femoral or femoro-popliteal vein segments over an 8-year period. Thirty-three were new onset of thrombosis in unoperated limbs, and 32 limbs had prior iliac vein stents. Venographic patency was established in 46/61 (75%) limbs. However, IVUS indicated residual thrombus in 53/61 (87%) limbs, and a thrombolytic catheter was inserted for lysis over the ensuing days. Complete thrombus resolution was achieved with catheter lysis in 10/53 (19%) of these limbs for a total of 16/61 (26%) limbs resolving their thrombus. Associated stenoses were corrected by stent placement in 51% of limbs based on IVUS control. Median follow up was 20 months. Recurrent thrombosis occurred in 9% of limbs. Valve reflux was detectable in 43% limbs, and PTS developed in 42% limbs. The very high IVUS incidence (87%) of residual thrombus after PMT, and even after follow-up catheter lysis (74%), is discouraging on the potential efficacy of thombolytic regimens in preventing PTS. Venography is clearly insensitive to residual thrombus. While venography can provide rough information on adequacy of inflow into the lysed segments, IVUS can assess residual thrombus more accurately and identify specific stenotic defects that can be corrected. Routine use of this device in thrombolytic regimens is recommended." @default.
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- W2054151036 date "2013-01-01" @default.
- W2054151036 modified "2023-10-17" @default.
- W2054151036 title "The Importance of IVUS Assessment in Venous Thrombolytic Regimens" @default.
- W2054151036 doi "https://doi.org/10.1016/j.jvsv.2012.10.030" @default.
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