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Below-the-knee access in entire-limb DVT viable alternative
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Below-the-knee access in entire-limb catheter-directed thrombolysis via a small saphenous vein or posterior tibial vein puncture is a safe and effective alternative to traditional access location, according to a study published in Catheterization and Cardiovascular Interventions.
According to Guang Liu, MD, PhD, from the department of vascular surgery at Shanghai Ninth People’s Hospital, acute deep vein thrombosis (DVT) is the third most common CV disorder and affects a broad range of patient populations.
“Catheter-directed thrombolysis (CDT) allows for selective thrombolysis in the affected vein, resulting in more rapid thrombus dissolution and fewer hemorrhagic complications compared to systemic infusion of a thrombolytic agent,” Liu and colleagues wrote. “Evidence shows that CDT enhances thrombus removal from the lower extremities, prolongs venous patency, prevents venous insufficiency and reduces DVT recurrence and the incidence and severity of [post-thrombotic syndrome], especially in patients with iliofemoral DVT.”
To assess the safety and efficacy of below-the-knee approach treatment of entire-limb DVT, the researchers performed it in 79 patients (mean age, 54 years; 51 men) with acute lower-extremity DVT.
Liu and colleagues performed CDT by accessing the ipsilateral small saphenous vein and posterior tibial vein.
Thirty-four patients underwent CDT within 3 days of symptom onset, and in all cases, lysis was successful, defined as grade 3 lysis.
Among the 32 patients treated within 4 to 10 days, 68.6% had successful lysis, and no patients treated after 10 days had grade 3 lysis, Liu and colleagues wrote.
Bleeding complications occurred in 16 patients, but none were classified as major. Eleven of these complications were related to numbness at the site of incision.
There was one instance of poor wound healing, and three patients who were treated using an small saphenous vein approach had partial occlusion.
At 24 months, the patency and post-thrombotic syndrome rates were 80.4% and 30.4%, respectively, Liu and colleagues wrote.
Overall, the patency rate for 62 patients during a mean follow-up duration of 3.5 years was 87.1%.
“The findings of this study are promising and provide support to the currently scarce and weak documentation on the prevention of [post-thrombotic syndrome] in entire-limb DVT,” the researchers wrote. – by Dave Quaile
Disclosure: The researchers report no relevant financial disclosures.
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