S. Roy et F. Laerum, Transcatheter aspiration: The key to successful percutaneous treatment of deep venous thrombosis?, ACAD RADIOL, 6(12), 1999, pp. 730-735
Rationale and Objectives, The purpose of this study was to examine transcat
heter aspiration as an adjunct to local thrombolysis in a porcine model of
acute deep venous thrombosis (DVT).
Materials and Methods. DVT was induced in both hind limbs of five pigs. Thi
rty minutes later, bilateral thrombolysis was performed by using infusion g
uidewires placed coaxially through occlusion balloon catheters. A temporary
venous filter was then placed in the inferior vena cava. The balloon cathe
ters and infusion wire were removed, a 14-F sheath was placed on the right
side, and aspiration of residual thrombi was attempted with 8- and 6-F cath
eters. At autopsy, the mass of any thrombus in the iliofemoral veins was me
asured, and residual thrombosis in the venous tributaries was graded at fou
r sites. Thromboemboli in the inferior vena cava and the pulmonary circulat
ion were also collected and weighed.
Results. With aspiration and lysis, the iliofemoral veins were cleared of t
hrombus in three of five limbs; from the remaining two, only 0.09 and 0.15
g of thrombus were harvested. Except for the deep femoral vein in two legs,
tributaries were free of thrombus. After thrombolysis alone, thrombi range
d in mass from 0.54 to 1.14 g (median, 0.70 g). Some thrombi were observed
in most tributaries. One or two small emboli were found trapped by the cava
l filter and in the pulmonary circulation in four and three pigs, respectiv
ely.
Conclusion. The primary axial veins and their tributaries can be rapidly cl
eared of thrombus by using thrombolysis with transcatheter aspiration, but
this procedure is associated with the risk of pulmonary embolism.