Interventional radiologists with Virginia Interventional & Vascular Associates (VIVA) report success over the past two years in treating acute deep vein thrombosis patients with isolated pharmacomechanical thrombolysis (IPMT), a procedure that disintegrates blood clots more rapidly than traditional therapies.
An interventional radiologist performs the two-hour, minimally invasive procedure at Mary Washington Hospital or Stafford Hospital using the FDA-approved Trellis® Peripheral Infusion System. The system consists of a catheter with two occluding balloons, drug infusion holes between the balloons, and mechanical drug dispersion capabilities.
Patients are given conscious sedation. VIVA’s interventional radiologists make a small percutaneous incision, inserting the catheter into the vein requiring the procedure. Using fluoroscopy to help them guide the catheter into position, VIVA doctors isolate the clot with balloons positioned at each end of
the catheter, infuse the clot with fibrinolytic medication, disintegrate it with a tiny oscillating wire, and aspirate the remaining particles.
John D. Statler, MD, a board-certified, fellowship-trained interventional radiologist with VIVA, said the procedure offers advantages over traditional therapies in appropriate cases. Traditional treatments include anticoagulant medication and catheter- directed thrombolysis.
Anticoagulant medication prevents the clot from enlarging and protects against pulmonary embolism (PE). PE kills on average one in every 100 people diagnosed with deep vein thrombosis (DVT), according to the Society of Interventional Radiology. Anticoagulation does not dissolve the clot, relying on the body to disintegrate it over time. The society estimates that 60–70 percent of DVT patients treated with anticoagulant medication alone develop post-thrombotic syndrome, with permanent leg damage, chronic pain, fatigue, swelling, and, in some cases, severe skin ulcers. Another treatment, catheter-directed thrombolysis, dissolves clots by delivering thrombolytic medication through catheters. However, this treatment also necessitates a 24- to 72-hour intensive care hospital stay and is associated with a risk of bleeding complications.
The IPMT procedure disintegrates clots more rapidly than possible using traditional therapies. This provides faster pain relief to patients and protection against post-thrombotic syndrome, Dr. Statler said. IPMT also requires a shorter hospital stay than catheter- directed thrombolysis and minimizes bleeding risks.
“With the IPMT procedure, we can destroy the clot and relieve pain for most patients within a couple of hours,” Dr. Statler stated. “It requires an overnight hospital stay, rather than intensive care for several days. The risk of bleeding also is lower than for catheter- directed thrombolysis.”
Indications and Contraindications
Dr. Statler noted that the safety and effectiveness of IPMT have been investigated in clinical studies. The American College of Chest Physicians Clinical Practice Guidelines for Venous Thromboembolic Disease, published in CHEST, July 2008, endorsed the procedure for select patients with extensive acute proximal DVT (e.g., iliofemoral DVT, symptoms for <14 days, good functional status, life expectancy of ≥1 year) who have a low risk of bleeding.
“We suggest pharmacomechanical thrombolysis (e.g., with inclusion of thrombus fragmentation and/or aspiration) in preference to catheter-directed thrombolysis alone to shorten treatment time if appropriate expertise and resources are available,” the guidelines stated.
Dr. Statler said the procedure is most effective for patients who have experienced symptoms for less than two to four weeks. Contraindications for the procedure include active bleeding.
Diagnosis and Treatment Options
The incidence of DVT increases with age and with certain conditions, such as cancer, recent surgery, recent trauma, and extended periods of immobility. According to the Office of the Surgeon General (OSG), DVT and pulmonary embolism contribute to at least 100,000 deaths nationwide each year. The OSG, along with the National Quality Forum and The Joint Commission, has called for more aggressive treatment of DVT.
VIVA performs vascular ultrasound studies to help referring physicians diagnose DVT. The practice’s interventional radiologists and vascular surgeon also provide a spectrum of treatment options that can be used individually or in combination, depending upon the patient’s condition. Treatments include anticoagulant medication, catheter-directed thrombolysis, IPMT using the Trellis system, and inferior vena cava filters.
For more information, contact John D. Statler, MD, at firstname.lastname@example.org or call (540) 361-1000 and leave a message.
The above picture shows The Trellis Peripheral Infusion System for treating acute DVT.