Pharmacomechanical Catheter-directed Thrombolysis in Patients with IVC Filters

SSJ26-03

Pharmacomechanical Catheter-directed Thrombolysis in Patients with IVC Filters

Scientific Papers

Presented on December 2, 2014
Presented as part of SSJ26: Vascular/Interventional (IR: Venous Disease and Intervention)

John Peter Karageorgiou MD, Presenter: Nothing to Disclose

Kathryn Jane Fowler MD, Abstract Co-Author: Research support, Bracco Group

Suresh Vedantham MD, Abstract Co-Author: Research support, Covidien AG Research support, Bayer AG Research support, F. Hoffmann-La Roche Ltd Research support, BSN medical GmbH

Nael El Said Saad MBBCh, Abstract Co-Author: Research Consultant, Veran Medical Technologies, Inc Proctor, Sirtex Medical Ltd

To evaluate the authors’ experience with pharmacomechanical catheter-directed thrombolysis (PCDT) in patients with inferior vena cava (IVC) filters.

Retrospectively queried radiology reports from 1/2005-2/2014 identified patients with IVC filters undergoing PCDT (catheter-directed thrombolysis, mechanical thrombectomy, balloon maceration, angioplasty and stenting). Patient electronic medical records were reviewed for: demographic, anticoagulation, symptoms, extremities involved, extent of thrombosis, therapies received, number of sessions, technical and clinical success, complications, need for subsequent lysis and long-term status. Statistic analyses were performed using SPSS software.

Eighty-two patients met criteria (53yrs; range 18-96, M:66%). The most common indication for PCDT was lower extremity pain and edema (68%) with ulceration, phlegmasia, and compartment syndrome, combined accounting for 16% and pulmonary embolism for 12% of patients. Of the 80 patients with lower extremity symptoms, 60% were bilateral, resulting in 129 extremities at risk. Catheter venography demonstrated IVC thrombus in 89% with extension above the filter in 22% of patients. Thrombus was confined to extremities in 5%, while IVC with both iliac vessel involvement was identified in 64% of patients. Treatment mostly involved combined mechanical and lytic therapy with angioplasty and stenting in 57% and 50% of patients, respectively. PCDT was technically successful in restoring flow in 88% and clinically successful in improving symptoms in 80%. IVC filters remained functional in 70%. By SIR criteria, 85% had no or minor complications. There were 2 deaths from intracranial hemorrhage. On follow up (458 days avg; 0-3011D), 6% of patients died from thrombosis related events, 17% underwent repeat lysis procedures within our hospital system and 54% of patients had resolved/improved symptoms. The complication rates in the patients with single versus bilateral lower extremity involvement were similar. Long-term thrombosis related death was 17% in patients with thrombus extending above the filter vs. 3% in patients with no thrombus extension above the filter.