Ultrasonic acselie catheter-interventioned thrombolize treatment in acute lower extremity deep venous thrombosis

Deep venous thrombosis (DVT) of lower extremity is the common cardivascular condition that has considerable morbidity and mortality. The annual incidence of DVT is 1-2 in 1000. DVT is the clot formation due to stasis, endothelial damage and hypercoagulability which is also known as Virchow triad. Pulmonary embolism, the most serious acute complication of DVT. It has been reported in 5% of treated and as many as 67% of untreated patients with lower-extremity DVT. Also venous gangren is an early complication of DVT which can causes loss of affected extremity . Venous hypertension that results in PTS is a late complication of DVT. The treatment of deep venous thrombosis aims to prevent complications like pulmonary embolism and hypertension, peripheral venous disease, recurrent venous thromboembolism and post thrombotic syndrome. Treatment is based on the use of anticoagulation, thrombolysis, surgical thrombectomy and percutaneous endovascular techniques. This study aims to evaluate retrospectively efficiency and reliability of ultrasonic accelerated catheter directed thrombolysis therapy in patients who had a diagnosis of acute iliofemoral-popliteal thrombosis detected by Doppler ultrasonography The study included 41 patients (17 women, 24 men, mean age 51) who had a diagnosis of acute iliofemoral-popliteal thrombosis detected by Doppler ultrasonography (US) from December 2012 to April 2015. The ultrasonic accelerated thrombolytic infusion catheter (EkoSonic® Endovascular System ,EKOS Corporation, Bothell, Washington, USA) was placed to the patients via the guide catheter (7F). Appropriate diameter and size stents were placed after PTA in 8 (%19.5) patients who have a more than % 50 stenosis at contol venography. Retrievable VCİ filters were placed in 4 (%9.7) patients level of infrarenal VCİ. Post interventional thrombosis clearance rates were controlled by venography. Patients were follow up by RDUS. In the control venography results were evaluated, successful recanalization rate of 90.2% was achieved. During follow-up venous structures in 23 patients (56%) fully recanalizaed, in 14 patients ( 34.1%) partially recanalizaed. mild PTS symptoms was observed in 14.6% of patients, no patients were diagnosed as severe PTS symptoms. Anticoagulation therapy does not have lytic effect to a thrombus and ıt does not prevent thrombus propagation adequately in iliofemoral-popliteal DVT. Systemic thrombolytic therapy has high major hemorrhagic complication and ıt ıs not specific to thrombotic area. Because of these limitations, new techiques are needed to lysis of thrombus by lower thrombolytic drug dosage. According to literature and results of our study, ultrasonic accelerated catheter directed thrombolysis is an alternative endovascular treatment which provides lower thrombolytic drug dosage. It has lower complication rates and increases efficacy of treatment by accelerating thrombolytic drug diffusion into thrombus.