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Isolated Pharmacomechanical Thrombolysis of Iliofemoral DVT

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Author(s): Shahram Askari

Journal: Iranian Journal of Radiology
ISSN 1735-1065

Volume: 6;
Issue: S1;
Start page: 73;
Date: 2009;
Original page

ABSTRACT
  "nA 38-year-old female presented with acute onset of swelling in the left lower extremity. She was diagnosed with extensive deep vein thrombosis (DVT) from the common iliac vein to the left femoral vein. On the initial venogram, the left femoral veins were patent. However, there was occlusive thrombus within the left common femoral vein extending to the left common iliac vein. The inferior vena cava (IVC) was patent. Procedure: "nFollowing overnight thrombolysis, a repeat venogram showed minimal improvement, and isolated pharmacomechanical thrombolysis with the Trellis(R) Peripheral Infusion System was performed. A minimal dose of t-PA was administered as the patient's fibrinogen levels had dropped. The catheter was removed and an 8 French sheath was placed. The Trellis System was advanced into position so that the distal balloon was positioned at the origin of the left common iliac vein. "nThe proximal balloon was placed within the femoral vein. 2 milligrams of t-PA was injected into the femoral and iliac venous system through the Trellis System catheter. The Trellis System device was run for 20 minutes. Following the first run, improvement of the flow was seen with minimal residual thrombus within the left external iliac. The device was run a second time for 20 minutes, using 2mg of t-PA. "nConclusion: Post-procedure venogram demonstrated restoration of patency within the left common iliac vein, with a stenosis noted in the left external iliac vein. A right iliac venogram was performed to show the location of the stenosis. A 14mm by 6cm covered stent was then deployed from the origin of the left common iliac vein to the external iliac vein and a second 14mm by 3cm stent was placed to treat the external iliac vein stenosis. Completion venogram demonstrated normalization of patency with brisk flow through the stents and into the patent IVC.  

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