Combined Approach Proves Optimal in Treatment of Extremity Veins

Results from a registry covering the clinical experience of 777 patients have found that a clot-busting mechanical device in combination with thrombolytic drugs is faster, more ef¬fective, and safer than thrombolysis alone for treating deep venous thrombus.

Isolated thrombolysis involving mechanical thrombectomy and thrombolytic drugs can successfully treat clots in just a few hours, restore vein blood flow, relieve pain, and prevent future clotting, said principal investigator Dr. Gerard J. O'Sullivan, an interventional radiologist at University College Hospital in Galway, Ireland.

O'Sullivan and coauthor Dr. Mahmood K. Rahzavi, an interventionalist at St. Joseph Hospital in Orange County, California, reviewed a voluntary patient registry sponsored by the manufacturer of the Trellis peripheral infusion catheter (Bacchus Vascular, Santa Clara, California). The registry included 777 patients with lower and upper extremity DVT who were treated at four centers worldwide from February 2005 to February 2008.

The authors have no financial relationship with the firm, O'Sullivan said.

A total of 827 limbs with acute (28%), acute/chronic (44%), subacute (11%), subacute/chronic (12%), and chronic (6%) DVT were treated with Trellis-based isolated thrombolysis. The approach achieved significant or total thrombus removal in approximately 97% of acute patients. Almost all other subgroups achieved more than 90% treatment success. Results were reported at the 2008 Society of Interventional Radiology meeting.

Treatment with the mechanical thrombectomy device does not require general anesthesia and can be performed in less than two hours on average. Because it requires lower doses of thrombolytic drugs, it can reduce the risk of bleeding and other complications as well as treatment costs.

"This is a very significant advance in DVT treatment, which hasn't changed in more than 40 years," O'Sullivan said. "It's a shift of thinking and is going to change the way DVT is treated."

-By H.A. Abella