RESUMO
The aim of this study was to evaluate the efficacy, safety, and feasibility of pulse-spray pharmaco-mechanical thrombolysis for treating patients with proximal deep vein thrombosis [DVT]. We studied 24 consecutive patients [14 men, 10 women, with mean age 36 years, range,19-59 years], with acute [less than 15 days] proximal DVT affecting the iliofemoral vein in 18 patients [75%], and/or femoro-popliteal vein in 6 patients [25%]. They were diagnosed by clinical examination, duplex ultrasonography. Contrast venography at the beginning of thrombolysis was done. All were treated with pulse-spray technique, using streptokinase, through the popliteal vein puncture under guidance of duplex scanning. Early success was assessed by comparing the pre- and post-treatment venographic severity score. All patients were discharged at oral Warfarin and followed by duplex scanning for one year. The average total dose of streptokinase was 3.6 million IU [range; 2.55-9.6 million IU] and the average duration of therapy was 2.4 days [range: 1-4 days]. Complete lysis was achieved in 12 patients [50%], partial lysis in 11 patients [45.8%], and suboptimal lysis in only one patient [4.1%]. Adjusted dose of heparin was used in conjunction with thrombolysis. In one case stenotic iliac vein lesion were uncovered after thrombolysis, and another one in the common femoral vein, both treated by balloon dilatation. There was no major treatment-related complication. The use of selective intra-thrombus pulse-spray pharmaco-mechanical thrombolysis was safe and effective approach for treating acute proximal DVT with minimal complications