Ultrasound‑Accelerated Catheter‑Assisted Thrombolytic TherapyApplicatıons in Deep Vein Thrombosis

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BACKGROUND: Ultrasound-accelerated catheter-directed thrombolysis (UCT) increases the invasion of thrombolytic agent into the thrombus using ultrasonic energy, provides less infusion of thrombolytic agent, reduces complication, and post-thrombotic syndrome (PTS) development rates. For these reasons, this procedure is a promising method for the treatment of deep vein thrombosis (DVT). MATERIALS AND METHODS: Patients diagnosed with DVT by ultrasonography (USG) who underwent UCT between May 2013 and August 2014 at Gazi University Hospital Cardiovascular Surgery Clinic were included in the study. The demographic characteristics and postoperative acute and long-term patency rates and deep venous insufficiency rates were evaluated retrospectively to determine the efficacy of the UCT procedure. Patients were classified as acute, subacute, and chronical DVT according to the onset of complaints. The efficacy of the UCT procedure was assessed by Doppler USG performed 6 months and 2 years after the procedure, and patients were re-evaluated for deep venous insufficiency and thrombus findings to determine the relationship between UCT procedure and deep venous insufficiency. RESULTS: In acute phase, 57.1% (n = 8) complete and 35.7% (n = 5) partial openings were obtained. No complete patency was obtained in any of the subacute patients. However, partial openness rate was 60%. In patients admitted during the chronic period, complete patency was obtained in 20% (n = 8) and partial openings in 60% (n = 3). Although thrombolysis success was not considered as statistically significant, the success rate was numerically higher in the acute phase. CONCLUSION: As a result, UCT applications provide thrombolysis especially in acute deep vein thrombosis, preventing deep venous insufficiency and especially post-thrombotic syndrome formation. UCT prevents bleeding complications by keeping thrombolytic amount low and can be used as an endovascular method of high safety in patient population with high bleeding complications such as patients with malignancies.