Jeffrey Y. Wang1, Naren Gupta2, Joseph D. Raffetto2, Shan-Ali Haider1, Richard Silva1, James L. Ebaugh2, Michael Sulkin1, Robert Fox1
1Shady Grove Adventist Hospital, Rockville, MD; 2VA Boston Healthcare System, Boston, MA.
OBJECTIVES: We retrospectively reviewed our experience with catheter directed treatment (CDT) of acute deep venous thrombosis (DVT) in an ambulatory setting at a community hospital.
METHODS: All patients treated with CDT for DVT (iliofemoral, inferior vena cava, innominate or subclavian) in an ambulatory setting at a single community hospital were retrospectively reviewed from June 1, 2009 to October 1, 2011. The diagnosis of DVT was made by duplex ultrasound or CTA scan. All were started on fractionated heparin and scheduled for ambulatory venous thrombectomy (AVT). The protocol included CDT infusion of 10 mg of alteplase (tPA) utilizing power pulse with subsequent tPA infusion at 1 mg/hr for a mean time of 2.2 hours with a range of 1.5 to 4 hours. Adjunctive procedures were performed for incomplete thrombus resolution. Outcome measured was primary venous patency.
RESULTS: Sixty-six patients (41 female) were treated in an ambulatory setting utilizing AVT. The mean age was 48.7 years (range 16-82 years). Complete primary resolution of thrombus was achieved in 12% of patients. Percutaneous mechanical thrombectomy was required in 58 patients (88%), angioplasty in 60 patients (90%), and stenting in 50 patients (76%). Technical success was achieved in all patients. All patients were discharged on the same day of treatment. There were no bleeding complications and no episodes of renal failure. All patients were placed on at least 6 months of anticoagulation. Primary patency was present in 61 patients (92%) at mean follow up of 14 months (range 3-24 months). There were 5 (7.6%) re-thrombosed veins, all 5 underwent repeat AVT and 3 are still patent.
CONCLUSIONS: Ambulatory venous thrombectomy is a safe, effective treatment and financially viable modality for acute deep vein thrombosis. Further studies with longer follow up are required to assess AVT in a prospective manner.
AUTHOR DISCLOSURES: J. L. Ebaugh, Nothing to disclose; R. Fox,: Nothing to disclose; N. Gupta, Nothing to disclose; S. Haider, Nothing to disclose; J. D. Raffetto, Nothing to disclose; R. Silva, Nothing to disclose; M. Sulkin, Nothing to disclose; J. Y. Wang, Nothing to disclose.
Posted April 2012