REGULAR CONTENT
Final ID
578
Type
Original Scientific Research-Oral or Pos
Authors
M Ertreo1, P O'Halloran2, H Bang2
Institutions
1Georgetown University Hospital, Washington, DC, 2Washington Hospital Center, Washington, DC
Purpose
To report a single center experience of sdPCDT for acute LE-DVT.
Materials & Methods
Single center, single operator retrospective chart review of patients having undergone sdPCDT for acute extensive LE-DVT from 1/1/2016 to 9/1/2016. Briefly, sdPCDT consists of popliteal access under moderate sedation, retrievable IVC filter deployment and catheter directed pharmaceutical thrombolysis performed infusing 5-10 mg of rTPA for 10-20 minutes depending on clot acuity, extension and patient weight. This is followed by active mechanical thrombectomy utilizing an Indigo device (Penumbra, Alameda, CA) and, at the operator's discretion, a Cleaner 15 device (Argon Medical Devices, Plano, TX). Percutaneous transluminal balloon venoplasty and/or stenting can be performed as warranted. Unilateral thigh-high compression stockings (20-30 mmHg) are immediately applied as the patients are transferred to the recovery area. Patients are discharged on therapeutic dose anticoagulation.
Results
13 patients underwent sdPCDT in the study period. 10 females (77%), mean age 59.5+/-19.5 years and BMI 33.8+/-5.1 underwent a single session of sdPCDT. 9 (69%) patients had left sided DVT and 4 (31%) right, 3 (23%) of which extending from popliteal into femoral vein, 6 (46%) into iliac vein and 4 (31%) into IVC. Mean fluoroscopy time and dose was 14.9+/-7.4 minutes and 1069.4+/-805.5 dGycm2, respectively. One patient with May Thurner syndrome required stenting of the left common iliac vein. 12 (92.3%) cases demonstrated total clot resolution on final venogram. Post-procedural Hgb decreased by mean 8.3% and HCT by 7.8%. Treated extremity sizing was recorded for 7 patients, with a 12 hour post-procedure thigh, calf and ankle diameters mean decrease of 2.0, 6.0 and 5.0%, respectively. All patients reported significant decrease of symptoms, mainly pain, and paresthesias. No complications were reported.
Conclusions
Short duration PCDT for LE-DVT can be a safe and effective alternative to traditional PCDT, performed utilizing prolonged rTPA infusion requiring ICU admission, potentially exposing the patient to increased risks such as bleeding (1). Given the small numbers currently available, a larger analysis is underway.
Final ID
578
Type
Original Scientific Research-Oral or Pos
Authors
M Ertreo1, P O'Halloran2, H Bang2
Institutions
1Georgetown University Hospital, Washington, DC, 2Washington Hospital Center, Washington, DC
Purpose
To report a single center experience of sdPCDT for acute LE-DVT.
Materials & Methods
Single center, single operator retrospective chart review of patients having undergone sdPCDT for acute extensive LE-DVT from 1/1/2016 to 9/1/2016. Briefly, sdPCDT consists of popliteal access under moderate sedation, retrievable IVC filter deployment and catheter directed pharmaceutical thrombolysis performed infusing 5-10 mg of rTPA for 10-20 minutes depending on clot acuity, extension and patient weight. This is followed by active mechanical thrombectomy utilizing an Indigo device (Penumbra, Alameda, CA) and, at the operator's discretion, a Cleaner 15 device (Argon Medical Devices, Plano, TX). Percutaneous transluminal balloon venoplasty and/or stenting can be performed as warranted. Unilateral thigh-high compression stockings (20-30 mmHg) are immediately applied as the patients are transferred to the recovery area. Patients are discharged on therapeutic dose anticoagulation.
Results
13 patients underwent sdPCDT in the study period. 10 females (77%), mean age 59.5+/-19.5 years and BMI 33.8+/-5.1 underwent a single session of sdPCDT. 9 (69%) patients had left sided DVT and 4 (31%) right, 3 (23%) of which extending from popliteal into femoral vein, 6 (46%) into iliac vein and 4 (31%) into IVC. Mean fluoroscopy time and dose was 14.9+/-7.4 minutes and 1069.4+/-805.5 dGycm2, respectively. One patient with May Thurner syndrome required stenting of the left common iliac vein. 12 (92.3%) cases demonstrated total clot resolution on final venogram. Post-procedural Hgb decreased by mean 8.3% and HCT by 7.8%. Treated extremity sizing was recorded for 7 patients, with a 12 hour post-procedure thigh, calf and ankle diameters mean decrease of 2.0, 6.0 and 5.0%, respectively. All patients reported significant decrease of symptoms, mainly pain, and paresthesias. No complications were reported.
Conclusions
Short duration PCDT for LE-DVT can be a safe and effective alternative to traditional PCDT, performed utilizing prolonged rTPA infusion requiring ICU admission, potentially exposing the patient to increased risks such as bleeding (1). Given the small numbers currently available, a larger analysis is underway.