Реферат
PURPOSE: To evaluate the efficacy of catheter-directed low-dose recombinant tissue-type plasminogen activator infusion in the treatment of iliofemoral deep venous thrombosis and prevention of post-thrombotic syndrome. METHOD: Eighteen patients (out of 260 evaluated) with acute iliofemoral deep venous thrombosis and no previous evidence of venous insufficiency were prospectively selected for thrombolytic therapy. Catheter-directed low-dose recombinant tissue-type plasminogen activator (1 mg/h) was infused into the thrombotic segments. RESULTS: Effective fibrinolysis was achieved in 14 of 18 cases, with correlation between effective fibrinolysis and major/complete resolution of acute signs and symptoms (P <.01). There were no episodes of major complications. Four patients presented with early rethrombosis (1 to 8 weeks). Individuals were followed for a period up to 131 weeks (average, 85.2). The incidence of clinical signs and symptoms of venous insufficiency and duplex-scan findings of valvular reflux was significantly lower in the patients in which lytic therapy succeeded and patency was kept, compared with patients experiencing acute therapeutic failure or rethrombosis (P <.01). CONCLUSIONS: Low-dose recombinant tissue-type plasminogen activator fibrinolytic therapy is safe and effective in the treatment of acute iliofemoral venous thrombosis. The late evolution as revealed clinically and by ultrasound was superior in patients for whom lytic therapy was effective.
OBJETIVOS: Avaliar a eficácia da infusão seletiva por cateter do ativador de plasminogênio tecidual recombinante em baixas doses no tratamento da trombose venosa iliacofemoral e na prevenção da síndrome pós-trombótica. MÉTODO: Dezoito pacientes (de 260 avaliados) portadores de trombose venosa profunda iliacofemoral sem evidência prévia de insuficiência venosa foram selecionados para terapia fibrinolítica e submetidos a infusão seletiva por cateter do ativador de plasminogênio tecidual recombinante na dose de 1mg/dl nos segmentos venosos trombóticos. RESULTADOS: Quatorze pacientes apresentaram fibrinólise efetiva; observamos correlação entre o grau de melhora clínica observado e a redução percentual do volume trombótico (P<.01). Não houve episódios de complicações graves. Quatro pacientes apresentaram retrombose precoce (1 a 8 semanas). Os pacientes foram seguidos por um período de até 131 semanas (média 85.2). A incidência de sinais e sintomas clínicos de insuficiência venosa e os achados ecográficos de refluxo valvular foram significativamente menores nos pacientes em que a terapia fibrinolítica foi efetiva e a perviedade mantida ao longo do período de seguimento, na comparação com os casos de falha aguda ou de retrombose precoce (P<.01). CONCLUSÕES: A terapia fibrinolítica da trombose venosa iliacofemoral com ativador de plasminogênio tecidual recombinante seletivo em baixas doses demonstrou-se eficaz e segura. A evolução clínica e ecográfica tardia foi superior nos pacientes em que a terapia lítica foi efetiva.
Тема - темы
Humans , Male , Female , Adolescent , Adult , Middle Aged , Femoral Vein , Fibrinolytic Agents/administration & dosage , Iliac Vein , Thrombolytic Therapy/standards , Tissue Plasminogen Activator/administration & dosage , Venous Thrombosis/drug therapy , Acute Disease , Catheterization, Peripheral , Epidemiologic Methods , Fibrinogen/analysis , Postphlebitic Syndrome/prevention & control , Recurrence , Treatment Outcome , Thrombolytic Therapy/methods , Ultrasonography, Doppler, Duplex , Vascular Patency , Venous ThrombosisРеферат
Avaliação imediata e tardia da terapia fibrinolítica da trombose venosa profunda iliacofemoral por infusão seletiva de rt-PA em baixas doses. Os pacientes foram submetidos à infusão transcateter de rt-PA (1mg/hora) nos segmentos venosos trombóticos, por um tempo médio de 41 horas. Houve fibrinólise efetiva em 12 dos 15 casos, com correlação entre o percentual de fibrinólise e a magnitude da melhora clínica aguda / Early and late evaluation of fibrinolytic therapy of iliofemoral deep venous thrombosis by selective infusion of low-dose rt-PA. Patients were submitted to transcatheter infusion of rt-PA (1mg/kg) in the thrombotic venous segments, with a mean lysis time of 41 hours. Effective lysis was reached in 12 of 15 cases. Statistic correlation between lysis grade and acute clinical improvement was observed...