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Rapid lysis technique removes DVT, prevents post-thrombotic syndrome
Monday, 29 November 1999 19:00 | 
| Radiology News - Radiology Articles |
Little did Vice President Dick Cheney know when visited his doctor on March 5 with a blood clot in his leg that an improved treatment for deep vein thrombosis was unveiled just a few days previously.
Deep vein thromboses (DVT) can be safely and effectively treated using a combined technique of physical thrombolysis and injection of an anticoagulant deep within the clot, according to the presentation at the annual meeting of the Society of Interventional Radiology on March 2.
"The standard therapy has been to treat the patient with an anticoagulant and then wait," presenter Dr. Mark Garcia told Reuters Health. "But the key is that, as that clot sits in that vein and does not dissolve, within a relatively short period of time there will be significant damage to the valves in the vein, which ultimately could lead to amputation."
"But if you can get in there and physically remove the clot, you can restore blood flow, and relieve the swelling and pain. It dramatically improves that patient's quality of life and prevents post-thrombotic syndrome."
Dr. Garcia, from Christiana Care Health System in Wilmington, Delaware, and his associates evaluated the safety and efficacy the AngioJet Rheolytic Thrombectomy System with thrombolytic infusate in patients with DVT.
Their retrospective analysis included 102 patients with large volume DVT between 1999 and 2006. Clot removal was 50 per cent to 100 per cent complete in 81 per cent of subjects.
To use the device, the interventional radiologist uses imaging to guide the catheter and the device into the vein and advances it to the blood clot.
"The machine uses high volume, high velocity jets of saline that contains an anticoagulant, such as tPA. The high pressure solution minces up the clot, allowing the medication to be driven deep within the clot," Dr. Garcia said.
He describes the system as a combination "blender and tornado effect," in which the high velocity solution creates a negative suction within the catheter to remove remnants of the clot.
Dr. Garcia's team has improved the original device by using an angled directional catheter that permits "wall-to-wall apposition, so as we spiraled backward with our catheter, we were removing more of the clot, especially the part of the clot that was more adherent to the vein wall".
"The standard therapy has been to treat the patient with an anticoagulant and then wait," presenter Dr. Mark Garcia told Reuters Health. "But the key is that, as that clot sits in that vein and does not dissolve, within a relatively short period of time there will be significant damage to the valves in the vein, which ultimately could lead to amputation."
"But if you can get in there and physically remove the clot, you can restore blood flow, and relieve the swelling and pain. It dramatically improves that patient's quality of life and prevents post-thrombotic syndrome."
Dr. Garcia, from Christiana Care Health System in Wilmington, Delaware, and his associates evaluated the safety and efficacy the AngioJet Rheolytic Thrombectomy System with thrombolytic infusate in patients with DVT.
Their retrospective analysis included 102 patients with large volume DVT between 1999 and 2006. Clot removal was 50 per cent to 100 per cent complete in 81 per cent of subjects.
To use the device, the interventional radiologist uses imaging to guide the catheter and the device into the vein and advances it to the blood clot.
"The machine uses high volume, high velocity jets of saline that contains an anticoagulant, such as tPA. The high pressure solution minces up the clot, allowing the medication to be driven deep within the clot," Dr. Garcia said.
He describes the system as a combination "blender and tornado effect," in which the high velocity solution creates a negative suction within the catheter to remove remnants of the clot.
Dr. Garcia's team has improved the original device by using an angled directional catheter that permits "wall-to-wall apposition, so as we spiraled backward with our catheter, we were removing more of the clot, especially the part of the clot that was more adherent to the vein wall".
