Efficiency of endovascular methods in managing late proximal deep vein thrombosis

Objective. To compare the effectiveness of managing late proximal deep vein thrombosis with different endovascular methods. 

Materials and methods. The treatment efficacy of 45 patients with proximal DVT was analyzed. The patients were split into three statistically valid groups, each consisting of 15 patients. The first group patients were treated with mechanical transcutaneous thrombectomy. The second group had catheter-guided thrombolysis therapy using Urokinase. In the third group the thrombolysis therapy and the thrombectomy were combined. Patients were given Rivaroxabane before, during, and after the therapy continuously for 6 months. The complications of thrombectomy and thrombolysis therapy were monitored during the treatment. After 12 months in order to reveal deep vein patency and the degree of venous outflow disturbance, the ultrasonography and clinical assessment were done. Venous lumen recanalization was scored in the following way. The minimal recanalization was considered as less than 50% of the lumen. The partial one was 50 to 99%. The restoration of 100% lumen patency was referred to as the complete one. 

Results. Recurrent DVT was found in 3 (6.7%) patients, 2 of whom belonged to the first and 1- to the second group. External hemorrhage after popliteal vein puncture and Urokinase injection developed in 1 patient from the second and 1 from the third group. Hemorrhagic complications after Rivaroxabane intake occurred equally in 6 (13.3%) patients from each groups. The complete restoration of the lumen patency is detected in 6.7%, the partial one - in 53.3%, and the minimal one - in 40% of first group patients, 20%, 53.3% and 26.7% in the second and 40%, 46.6% and 13.3% of the third group patients respectively. Severe venous congestion developed in 40% of first group patients, 20% in the second, and 6.7% of the third group patients respectively. Moderate venous congestion developed in 33%, 26.6 % and 13.6% of patients respectively. Mild congestion was in 20%, 33.4% and 40% of patients. 

Conclusion. The combined treatment of late DVT with transcutaneous thrombectomy and catheter-guided thrombolysis therapy accompanied by long-lasting anticoagulation therapy with Rivaroxabane is an option of choice.

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