Popliteal ven tutulumu olmayan akut iliofemoral ven trombozunun ultrasonla hızlandırılmış kateter aracılı trombolitik tedavisi: erken ve orta dönem sonuçlar

Amaç: Derin ven trombozu hayatı tehdit eden bir patoloji olup uzun dönemde post-trombotik sendrom gibi morbiditelere sebep olmaktadır. Bu çalışmanın amacı popliteal veni açık olan ilio-femoral derin trombozu nedeniyle ultrason ile hızlandırılmış kateter aracılı tromboliz tedavisi yapılan hastaların erken ve orta dönem sonuçlarını değerlendirmektir. Gereç ve Yöntem:  Kasım 2014-Aralık 2015 tarihleri arasında akut iliofemoral derin ven rombozu nedeniyle ultrason ile hızlandırılmış kateter aracılı tromboliz tedavisi uygulanan 18 hasta (11 erkek, 7 bayan; ortalama yaş 51,89±16,29 yıl)  retrospektif kesitsel olarak planlanan çalışmaya dahil edilmiştir. Bulgular:  Hastaların % 88,9 unda (16/18) komplet tromboliz, 2 hastada parsiyel tromboliz başarıyla sağlanmıştır. Pulmoner embolism gözlenmedi. Bir hastada kateter yerinde kanama gözlendi. Parsiyel lizis olan bir hastada altta yatan lezyon balon anjioplasti ile başarılı olarak tedavi edilmiştir. Hastane mortalitesi veya ciddi bir komplikasyon gözlenmemiştir. Ortalama takip süresi 31,56±3,35 aydır. Tüm hastaların ultrason bulguları, aynı deneyimli bir radyolog tarafından değerlendirilmiştir. Dopler ultrasonografi kontrolleri girişim sonrası 1 ve 6. ay ile 1 ve 2. yılda yapılarak raporlanmıştır. İliak ven açıklık oranı % 100 saptandı. Fakat sırasıyla 5,6% (1 hasta), 11.1% (2 hasta),16,2% (3 hasta), 16,2% (3 hasta) yüzeyel femoral vende yetmezlik saptandı. Sonuç:  Çalışmamızın sonuçlarına göre, popliteal veni patent olup ilio-femoral derin ven trombozu olan dikkatli seçilmiş hastalarda ultrason ile hızlandırılmış kateter aracılı tromboliz tedavisi güvenli ve efektif bir metodtur. 

Ultrasound accelerated catheter directed thrombolysis for treatment of acute iliofemoral deep venous thrombosis without popliteal vein thrombosis: early and midterm results

Purpose: Deep vein thrombosis is a life-threatening pathology which can lead to long-term morbidity due to post-thrombotic syndrome. The aim of this study was to assess early and midterm results of the patients undergoing ultrasound-accelerated catheter-directed thrombolysis for the treatment of acute iliofemoral deep venous thrombosis without popliteal vein thrombosis.Materials and Methods: A total of 18 patients (11 males, 7 females; mean age: 51.89±16.29 years; range, 16 to 72 years) who were diagnosed with acute iliofemoral deep vein thrombosis between November 2014 and December 2015 were included in this retrospective cross-sectional study. Results:  Complete thrombolysis was successful in 88.9% (n=16) and in % 11.1 (n=2) patients with partial clot lysis. No pulmonary embolism was seen, while bleeding at the catheter-insertion site was observed in one patient. In another patient, underlying lesions were successfully treated with balloon angioplasty. No in-hospital mortality or severe complications were observed. The mean follow-up was 31.56±3.35 (range, 25 to 37 months). Ultrasound findings of all the patients were evaluated by a single experienced radiologist. Duplex ultrasound was performed at one month, six months, one year, and two years following intervention and the iliac vein patency rate was found to be 100%, while superficial femoral vein insufficiency was in 5.6% (n=1), 11.1% (n=2), 16.2% (n=3), and 16.2% (n=3), respectively.Conclusion: Based on our findings, ultrasound-accelerated catheter-directed thrombolysis is a safe and effective method for carefully selected patients with acute iliofemoral deep vein thrombosis without popliteal vein thrombosis

Kaynakça

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