Catheter-Directed Thrombolysis of Acute Entire Limb Deep Vein Thrombosis From below the Knee Access: A Retrospective Analysis of a Single-Center Experience.

PURPOSE: To evaluate the safety and efficacy of below the knee (BTK) approach in the treatment of entire limb deep vein thrombosis (DVT). MATERIALS AND METHODS: Retrospective analysis of consecutive CDT treatment of acute entire limb DVT using a BTK approach (September 2010-February 2016) was performed. The patients included 51 men and 28 women with a mean age of 54 years. RESULTS: CDT was performed by accessing the ipsilateral the small saphenous vein (SSV) and posterior tibial vein (PTV; 24 via incision and 64 via puncture). Thirty-four patients underwent CDT within 3 days of symptom onset and lysis was successful in all cases (i.e., grade III).In contrast, only 22 (68.6%, 22/32) of those treated within 4-10 days and 0 (0%) of those treated after 10 days achieved grade III lysis. A total of 16 bleeding complications occurred, none of which were classified as major, and 11 of which were related to numbness at the site of incision. Poor wound healing was observed in one patient. Three patients treated using an SSV approach exhibited partial occlusion. One patient treated using a PTV approach experienced occlusion. During the 24-month follow-up period, the patency and PTS rates were 80.4% (37/46) and 30.4% (14/46), respectively. The overall patency rate was 87.1% (54/62) during a mean follow-up duration of 3.5 years. CONCLUSIONS: The use of a BTK approach in entire-limb DVT via SSV and PTV puncture is feasible and safe and may be considered an alternative to traditional CDT approach. © 2017 Wiley Periodicals, Inc.

Endovascular management of extensive lower extremity acute deep vein thrombosis with AngioJet rheolytic thrombectomy plus catheter-directed thrombolysis from contralateral femoral access.

PURPOSE: The aim of the present study was to report the clinical outcomes of endovascular treatment for extensive lower limb deep vein thrombosis with AngioJet rheolytic thrombectomy (ART) plus catheter-directed thrombolysis (CDT) using a contralateral femoral approach. METHODS: A retrospective analysis of consecutive ART+CDT treatments in 38 deep vein thrombosis patients (LET I-III, from September 2014 to March 2016) was performed. RESULTS: The technical success rate was 100%. Complete lysis was achieved in 82% of LET III segments (calf veins), 87% of LET II segments (popliteal-femoral veins), and 90% of LET III segments (iliac veins). The best results were obtained in patients treated within seven days of symptom onset. During follow-up, well-preserved, competent femoral valves were observed in 86% of the patients, and recanalization of LET III, LET II, and LET I segments was achieved in 100%, 94%, and 91% of the patients, respectively. The post-thrombotic syndrome rate was 17% during a mean 20-month follow-up.

Staged endovascular repair of critical limb ischemia in high risk patients: the procedural and clinical outcomes.

BACKGROUND: The aim of this paper was to retrospectively evaluate the procedural and clinical outcomes after staged angioplasty in high-risk, chronic, critical limb ischemia (CLI) patients. METHODS: Between 2013 and 2015, 29 patients (29 limbs) (mean age 77 years) were treated by staged revascularization procedures in 1) the iliac artery-DFA alone or with the femoropopliteal artery followed by 2) the femoropopliteal artery and a below-the-knee artery. All patients had long-segment iliofemoral artery and below-the-knee artery (TASCII D) occlusions with abnormal serum myoglobin and ischemic lesions. Clinical outcome was assessed at 1, 3, 6, and 12 months. Clinical treatment efficacy was defined as patient survival with resolved CLI without major amputations after the last revascularization procedure. RESULTS: Angioplasty was performed in all limbs with a technical success rate of 100%. All the patients received 2 stage endovascular interventions. The interval time between the two stages was 19.56±6.56 days. In the second stage, the peroneal artery (PA) in 11 patients, the anterior tibial artery (ATA) in 7 patients, both the PA and ATA in 6 patients, and the posterior tibial artery (PTA) in 6 patients were recanalized. Rest pain and lesions were resolved in all patients after the second-stage revascularization. An upward shift of limb status and EQ-5D scores after the first or second revascularization indicated a significant change. No major amputations occurred, although minor amputations were required in 5 patients within 3 months after the second endovascular revascularization. The primary patency was 82.76%. Repeat TLR was necessary for 5 patients after endovascular BTK revascularization. Clinical treatment efficacy was 71% at 12 months; the cumulative rate of repeat target limb revascularization was 45.6%. CONCLUSIONS: Staged endovascular treatment in high-risk CLI patients can effectively relieve rest pain and symptoms of necrosis, which greatly improves the survival and quality of life of patients less suited for conventional repair.