The Effectiveness of Catheter-directed Thrombolysis for First Line Deep Vein Thrombosis Therapy

PURPOSE: Untreated deep vein thrombosis (DVT) is associated with morbidity and mortality, such as pulmonary embolism and post-thrombotic syndrome. Anticoagulation therapy is efficient for reducing thrombus propagation but is insufficient for clot lysis or preventing post thrombotic syndrome. Current catheter-directed thrombolysis is an important DVT treatment. We compared the outcomes between anticoagulation therapy and DVT catheter-directed thrombolysis. The purpose of this study was to evaluate treatment outcomes in patients with symptomatic DVT who had undergone catheter-directed thrombolysis. METHODS: From January 2003 to January 2009, we retrospectively reviewed 91 patients who had been admitted and treated for DVT in our hospital. We divided 91 patients into two groups according to treatment method; 42 patients (46.2%) were treated with only anticoagulation, and 49 patients (53.8%) were treated with catheter-directed thrombolysis. We compared the results of the two treatments groups. The results included gender, symptom onset, age, location, complications, risk factors, days to improved patient symptoms and patency. All patients underwent Doppler sonography or CT-venography at 3 and 6 months to evaluate venous patency after treatment. RESULTS: 49 patients who underwent catheter-directed thrombolysis for DVT had more symptom-relief days (25.00 days, P<0.001). The 43 patients (88%) of the catheter-directed thrombolysis group showed more complete resolution on Doppler sonography or CT-venography after 6 months (P=0.001). We obtained better clinical outcomes in the catheter-directed thrombolysis group than in the anticoagulation only group. CONCLUSION: Catheter-directed thrombolysis is an effective treatment for acute DVT.

The Anatomical Properties of Size of Abdominal Aorta in Korean Normal Adult Populations

PURPOSE: The diameter of the abdominal aorta is an important criterion for making the diagnosis of abdominal aortic aneurysm. But the diagnostic criteria for the aortic diameters and the aneurysms are based on western people' s data, and there is scant data on this for Koreans. In this study, we measured a normal range of the abdominal aortic diameter of Korean adults and we classified the diameters according to age, gender and the body mass index (BMI). METHODS: The data is based on 496 patients (male: 281, female: 215) who had no evidence of vascular disease on abdominal multi detector computed tomography exams that were been done between October through December of year 2007 at our hospital. The abdominal aorta was measured at the smallest outer diameter of the infrarenal aorta and the upper bifurcation level. The age of the patients was from 20 to 70 years-old and the patients were divided into 6 groups by age. The patients were also divided into three groups according to their BMI (the low weight, normal weight and over weight groups). We computed the average and standard deviation of the aortic dimensions from each group. RESULTS: The average diameter at the infrarenal aorta was 18.32 mm and that at the upper bifurcation level was 17.25 mm. The males' average aortic diameter at the infrarenal aorta and at the upper bifurcation level was 19.23 mm and 18.10 mm, respectively, and those values for the females were 17.09 mm and 16.20 mm, respectively. In both the males and females, the diameter increased with increasing patient age (P<01). For the BMI, the diameter was larger for the higher BMI group. CONCLUSION: For the normal Korean population, the diameter of the abdominal aorta increases with aging and with an increased BMI, but the changes were relatively smaller as compared with the western normal range. More studies are needed to determine Koreans' normal range of the diameter of the abdominal aorta and this data can be applied to the diagnosis and treatment of abdominal aortic aneurysm.

Endovascular Aortic Aneurysm Repair in a Renal Transplant Recipient:a Case Report

Endovascular aneurysm repair (EVAR) has gained increasing acceptance and success. We report here on a case of EVAR in a patient with renal allograft. EVAR was performed using an aorto-biiliac endovascular graft system in a 65-year-old man who underwent kidney transplantation in the right iliac fossa. The donor renal artery was anastomosed to the recipient' s internal iliac artery. The preoperative renal function was normal. The size of the aneurysm was 5.5 cm in transverse diameter and the length of the distal neck was 2 cm to the right internal iliac artery. After the procedure, the completion angiogram demonstrated the good position of the endograft; however, we found a type II endoleak from the IMA. The postoperative renal function was not changed and the patient was discharged home after an uneventful hospital course. At the 6 month follow-up, the type II endoleak was noted to have decreased on the CT angiogram and the patient has remained well with a stable allograft renal function.

Bilateral Persistent Sciatic Arteries with Unilateral Complication:a Case Report

The sciatic artery is a major artery of the lower limb bulb during the early embryonic period. Its failure to regress is sometimes associated with femoral artery hypoplasia, and therefore, the dominant inflow to the lower extremity is called a persistent sciatic artery (PSA). This anomaly is often associated with a higher rate of aneurysm formation or thromboembolic complications that cause lower extremity ischemia. A 51-year-old man presented with complaints of right calf pain and a several month history of progressive claudication. CT angiography showed bilateral PSAs originating from hypogastric arteries. A long segment of the right PSA showed aneurysmal dilatation and thrombotic occlusion and the superficial femoral artery showed hypoplastic change. Focal segmental occlusion of the right popliteal artery below the knee was seen. He received a right femoro-posterior tibial bypass with a reversed saphenous vein graft. The patient' s postoperative course was uneventful and no complications were observed at 16 weeks follow-up.