Pharmacomechanical thrombectomy for acute symptomatic lower extremity deep venous thrombosis.

BACKGROUND: The purpose of this study was to evaluate the efficacy and safety of pharmacomechanical thrombectomy performed by using a rotational thrombectomy device for the treatment of deep vein thrombosis. METHODS: Between April 2012 and November 2014, 17 patients with acute deep vein thrombosis underwent pharmacomechanical thrombolysis. The thrombectomy device was used in a single-session technique for patients with lower-extremity deep vein thrombosis. After the procedure, the effect of thrombolysis was evaluated in 3 grades venographically. Grade I showed lysis of under 50%, and grade III showed complete lysis. RESULTS: Ten patients (58.8%) had an iliofemoral thrombosis and 7 (41.2%) had a femoropopliteal venous thrombosis. At the end of the pharmacomechanical thrombectomy procedure, 12 patients (70%) had complete (grade III) thrombus resolution. Grade I and II lysis were noted in 2 (12%) and 3 (18%) patients, respectively. Additionally, four (23.5%) required an additional lytic infusion as a result of residual thrombi. The overall grade III, II, and I thrombus resolution rates, including the supplemental thrombolysis, were 82.2% (n = 14), 12% (n = 2), and 5.8% (n = 1), respectively. There was no mortality. CONCLUSION: Based on the present data, use of the Cleaner thrombectomy device may prove to be a safe and feasible single-session pharmacomechanical thrombectomy method for the treatment of acute deep vein thrombosis. To prove the effectiveness of this type treatment, a more extensive large-scale studies are needed.

Chronic dissecting aneurysm of the ascending aorta developed in a patient who had rejected surgical treatment for type II acute ascending aortic dissection three years earlier.

A 66-year-old male patient was admitted to our clinic because of shortness of breath and chest pain. A grade 4/6 diastolic murmur was heard on auscultation. Physical examination revealed signs of congestive heart failure and poor peripheral perfusion. There was a diagnosis of type II ascending aortic dissection in the history of the patient. He had refused emergency surgical intervention three years earlier. Computed tomography revealed that the ascending aorta was dilated to about 10 cm in diameter, and there was a chronic aortic type II dissection. The patient had second- to third-degree aortic insufficiency and he had a calcified bicuspid aortic valve on echocardiography. Two-vessel disease and a 90-mmHg aortic gradient were detected on angiography. Graft replacement of the ascending aorta, serape aortic valve replacement with a mechanical valve, and coronary arterial bypass grafting were performed successfully under cardiopulmonary bypass with an open aortic technique. The patient was discharged on the 10th postoperative day with no problems.