Adil POLAT, İlknur AKDEMİR, Serkan KETENCİLER, İbrahim YILDIZHAN, Zeynep Gülben KÜK, Vedat ERENTUĞ, Cihan YÜCEL, Kamil BOYACIOĞLU

Derin ven trombozunda kateter-aracılı mikrodalga ultrason ile hızlandırılmış trombolitik tedavi: Orta dönem sonuçlar

Amaç: Bu çalışmada kliniğimizde iliofemoral derin ven trombozu (DVT) olan hastalarda uygulanan kateter-aracılı mikrodalga ultrason ile hızlandırılmış trombolitik tedavinin (EKOS) erken ve orta dönem sonuçları retrospektif olarak analiz edildi.Çalışmaplanı:Kliniğimizde 16 hastaya (12 erkek, 4 kadın; ort. yaş 50.2±18.2 yıl; dağılım 20-86 yıl) EKOS uygulandı. Dokuz hastada sol ve yedi hastada sağ alt ekstremitede DVT vardı. Semptomların başlangıcından itibaren ortalama tedavi süresi 8.2±5.2 gün idi. Standart EKOS'a ek olarak altı hastaya aynı taraf ayak dorsal venine yerleştirilen bir anjiyoket içerisinden 1/3 dozajında ek trombolitik verildi. Hastaların fibrinojen seviyeleri periyodik olarak takip edildi ve kritik seviyenin altına düşüldüğünde trombolitik kesilerek heparin infüzyonu ile devam edildi. Ortalama trombolitik infüzyonu süresi 18.4±9.8 saat (dağılım, 6-48 saat) ve ortalama trombolitik dozu 38.2±18.1 mg (dağılım, 13-90 mg) idi.Bul gu lar: Yedi hastada (%43.8) tam açıklık sağlandı. Bir hastada (%6.3) işlem sonrası retroperitoneal hematom gelişti. Takip sırasında mortalite olmadı. Ortalama ve toplam takip süreleri sırasıyla 9.3±8.3 ay (dağılım, 0.9-24.3 ay) ve 148.7 hasta/ay idi. Son kontrollerde 10 hasta (%62.5) asemptomatik veya hafif semptomatik idi ve iki hastada (%12.5) posttrombotik sendrom vardı. Üç hastada (%18.8) DVT nüksü görüldü. Nükssüz ortalama ve toplam takip süreleri sırasıyla 7.6±7.3 ay ve 122.0 hasta/ay oldu. Takip süresince hiçbir hastada pulmoner emboli yoktu Sonuç: Kateter-aracılı mikrodalga ultrason ile hızlandırılmıştrombolitik tedavisi ile DVT sonrası posttrombotik sendrom insidansısadece antikoagülan kullanımına göre literatürde belirtilen %25-%50insidansından daha düşüktü. Buna rağmen, asemptomatik veya hafifsemptomatik hastaların oranı beklendiği kadar yüksek değildi. Tedavietkinliğinin değerlendirilmesi için daha büyük ölçekli çalışmalar vediğer farmakomekanik tedaviler ile yapılacak karşılaştırmalar gereklidir.

Accelerated catheter-directed thrombolytic treatment in deep venous thrombosis: mid-term results

Background: This study aims to retrospectively analyze the early and mid-term results of ultrasound accelerated catheter-directed thrombolytic treatment (EKOS) performed in our clinic in patients with iliofemoral deep venous thrombosis (DVT).Methods: In our clinic, EKOS was performed in 16 patients (12 males, 4 females; mean age 50.2±18.2 years; range 20 to 86 years). Deep venous thrombosis was present on the left lower extremity in nine and right lower extremity in seven patients. Mean duration of treatment from the onset of symptoms was 8.2±5.2 days. Additional to standard EKOS, six patients were administered additional thrombolytic via an angiocath placed in dorsal vein of ipsilateral foot in 1/3 dosage. Patients' fibrinogen levels were monitored periodically and thrombolytic treatment was stopped under critical levels with continuation of heparin infusion. Mean duration of thrombolytic infusion was 18.4±9.8 hours (range, 6-48 hours) and mean dose of thrombolytic was 38.2±18.1 mg (range, 13-90 mg).Results: Complete patency was obtained in seven patients (43.8%). One patient (6.3%) developed post-procedural retroperitoneal hematoma. No mortality occurred during follow-up. Mean and total durations of follow-up were 9.3±8.3 months (range, 0.9-24.3 months) and 148.7 patient/months, respectively. In the final controls, 10 patients (62.5%) were asymptomatic or mildly symptomatic, and two patients (12.5%) had post-thrombotic syndrome. Recurrence of DVT was observed in three patients (18.8%). Recurrence-free average and total durations of follow-up were 7.6±7.3 months and 122.0 patient/months, respectively. No patients had pulmonary emboli during follow-up.Conclusion: Incidence of post-thrombotic syndrome after DVT with EKOS treatment was lower than the reported 25%-50% incidence in the literature compared to only anticoagulant usage. However, rate of asymptomatic or mildly symptomatic patients was not as high as expected. Larger scale studies and comparisons with other pharmacomechanical treatments are required to evaluate treatment efficiency.

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