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Device Specific Volumetric Analysis of Clot Lysis Using Intravascular Ultrasound in Ileofemoral DVT

Frank R. Arko, III, Erin H. Murphy, Eric J. Johnson, Stephen T. Smith, J. Gregory Modrall, G. Patrick Clagett.
University of Texas Southwestern Medical Center, Dallas, Texas.
 
OBJECTIVES: Pharmomechanical lysis offers the opportunity of clot lysis within the venous system. Venography is the imaging modality most commonly used to assess clot lysis. The purpose of this study is to assess the effectiveness of lysis using IVUS as compared to venography and to assess lysis using two different pharmomechanical devices in ileofemoral DVT.

METHODS: Between 2004-2007 33 patients with ileofemoral DVT were treated either with the Possis Angiojet (n=18) or the Trellis (n=15). 10 mg of TNK was used with both devices. IVUS analysis of the ileofemoral segment was performed over a 20 cm segment. IVUS was able to delineate the venous wall as well as any remaining thrombus within the vessel. A DICOM viewer was used to view the recorded loop and a SCION PCI Frame Grabber was used to determine the size of the vein as well as the diameter of recanalized vessel to assess clot lysis.

RESULTS: All 33 patients were successfully recanalized. Venography and IVUS were performed and compared post procedure to assess clot lysis. The mean diameter of the venous segment of all patients was 13.4±2.3 mm (range 10-15 mm). The mean volume of the venous segment was 2819±83.1 mm3. Following pharmomechanical lysis in all patients the volume of the recanalized segment was 2255.2±66.4 mm3 representing 80% lysis of the clot with IVUS compared to what was perceived as greater than 90% lysis with venography (p<0.05). There were no differences in patient demographics between the two devices. The volume of the venous segment in patients treated with the Possis angiojet with power pulse spray was 2826±84 .2 mm3, the volume of the recanalized segment was 2486±73.92 mm3 representing 88% lysis. The volume of the venous segment in patients treated with the Trellis was 2813±79.1 mm3, the volume of the recanalized segment was 2025.4±57.0 mm3 representing 72% lysis (p<0.01).

CONCLUSIONS: This represents the first report of volume analysis of clot lysis using IVUS in ileofemoral DVT. IVUS can easily and readily determine the amount of clot lysis following pharmomechanical lysis and is superior to venography. The Possis Angiojet with power pulse spray is associated with significantly greater clot lysis than the Trellis.

AUTHOR DISCLOSURES: F.R. Arko, None; E.H. Murphy, None; E.J. Johnson, None; S.T. Smith, None; J.G. Modrall, None; G.P. Clagett, None.