Correlation between Post-Procedure Residual Thrombus and Clinical Outcome in Deep Vein Thrombosis Patients Receiving Pharmacomechanical Thrombolysis in a Multicenter Randomized Trial.
Adolescent
Adult
Aged
Female
Femoral Vein
/ diagnostic imaging
Fibrinolytic Agents
/ administration & dosage
Humans
Iliac Vein
/ diagnostic imaging
Male
Middle Aged
Phlebography
Popliteal Vein
/ diagnostic imaging
Postthrombotic Syndrome
/ etiology
Thrombolytic Therapy
/ adverse effects
Time Factors
Tissue Plasminogen Activator
/ administration & dosage
Treatment Outcome
United States
Venous Thrombosis
/ complications
Young Adult
Journal
Journal of vascular and interventional radiology : JVIR
ISSN: 1535-7732
Titre abrégé: J Vasc Interv Radiol
Pays: United States
ID NLM: 9203369
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
08
06
2020
revised:
06
07
2020
accepted:
07
07
2020
pubmed:
20
9
2020
medline:
25
11
2020
entrez:
19
9
2020
Statut:
ppublish
Résumé
To evaluate relationships between immediate venographic results and clinical outcomes of pharmacomechanical catheter-directed thrombolysis (PCDT). Venograms from 317 patients with acute proximal deep vein thrombosis (DVT) who received PCDT in a multicenter randomized trial were reviewed. Quantitative thrombus resolution was assessed by independent readers using a modified Marder scale. The physician operators recorded their visual assessments of thrombus regression and venous flow. These immediate post-procedure results were correlated with patient outcomes at 1, 12, and 24 months. PCDT produced substantial thrombus removal (P < .001 for pre-PCDT vs. post-PCDT thrombus scores in all segments). At procedure end, spontaneous venous flow was present in 99% of iliofemoral venous segments and in 89% of femoral-popliteal venous segments. For the overall proximal DVT population, and for the femoral-popliteal DVT subgroup, post-PCDT thrombus volume did not correlate with 1-month or 24-month outcomes. For the iliofemoral DVT subgroup, over 1 and 24 months, symptom severity scores were higher (worse), and venous disease-specific quality of life (QOL) scores were lower (worse) in patients with greater post-PCDT thrombus volume, with the difference reaching statistical significance for the 24-month Villalta post-thrombotic syndrome (PTS) severity score (P = .0098). Post-PCDT thrombus volume did not correlate with 12-month valvular reflux. PCDT successfully removes thrombus in acute proximal DVT. However, the residual thrombus burden at procedure end does not correlate with the occurrence of PTS during the subsequent 24 months. In iliofemoral DVT, lower residual thrombus burden correlates with reduced PTS severity and possibly also with improved venous QOL and fewer early symptoms.
Identifiants
pubmed: 32948386
pii: S1051-0443(20)30587-X
doi: 10.1016/j.jvir.2020.07.010
pmc: PMC7541749
mid: NIHMS1629461
pii:
doi:
Substances chimiques
Fibrinolytic Agents
0
Tissue Plasminogen Activator
EC 3.4.21.68
Types de publication
Clinical Trial, Phase III
Journal Article
Multicenter Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1517-1528.e2Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR000448
Pays : United States
Organisme : NHLBI NIH HHS
ID : U54 HL112303
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002345
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL088118
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL088476
Pays : United States
Informations de copyright
Copyright © 2020 SIR. Published by Elsevier Inc. All rights reserved.
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