Browse > Article

Aspiration Thrombectomy Using a Guiding Catheter in Acute Lower Extremity Deep Vein Thrombosis: Usefulness of the Calf-Squeeze Technique  

Lee, Jae-A (Department of Radiology, Chonbuk National University Medical School)
Kwak, Hyo-Sung (Department of Radiology, Chonbuk National University Medical School)
Han, Young-Min (Department of Radiology, Chonbuk National University Medical School)
Yu, Hee-Chul (Department of Surgery, Chonbuk National University Medical School)
Publication Information
Journal of the Korean Society of Radiology / v.64, no.3, 2011 , pp. 231-238 More about this Journal
Abstract
Purpose: The effectiveness of the calf-squeeze technique during aspiration thrombectomy using guiding catheter in the treatment of an acute lower extremity deep vein thrombosis (DVT) was evaluated by the use of imaging and the clinical follow-up of patients. Materials and Methods: A prospective analysis of ten patients (seven women, three men; median age, 56.9 years) with common iliac vein (CIV) obstruction and ipsilateral DVT was performed for this study. All patients presented with leg edema or pain and were treated with catheter-directed thrombolysis via an ipsilateral popliteal vein approach after insertion of a temporary inferior vena cava (IVC) filter. Subsequently, the patients were treated with by aspiration thrombectomy using a guiding catheter to remove the residual thrombus. The calf-squeeze technique during aspiration thrombectomy can be used to induce the proximal migration of thrombi in the popliteal, tibial, and muscular veins were used to increase venous flow. Results: The calf-squeeze technique was employed at mean of 1.3 times (range, 1-3 times). All patients showed proximal migration of a popliteal and muscular vein thrombus during the execution of the calf-squeeze technique. Successful recanalization was achieved in all patients (100%) without any complications. On duplex ultrasonography, which was performed immediately after the aspiration thrombectomy, four patients had a residual thrombus in the soleal muscular veins. However, none of the patients had a thrombus in the popliteal and tibial veins; and, during follow-up, no DVT recurred in any patient. Conclusion: The use of the calf-squeeze technique during aspiration thrombectomy after catheter-directed thrombolysis can induce the proximal migration of thrombi in the popliotibial and muscular veins and is an effective method that can remove a thrombus in calf veins.
Keywords
Vein; Venous Thrombosis; Thrombolytic Therapy;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Markel A, Manzo RA, Bergelin RO, Strandness DE Jr. Valvular reflux after deep vein thrombosis: incidence and time occurrence. J Vasc Surg 1992;15:377-384   DOI
2 Akessoon H, Brudin L, Dahlstom JA, Eklof B, Ohlin P, Plate G. Venous function assessed during a 5 year period after cute iliofemoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg 1990;4:43-48   DOI   ScienceOn
3 Comerota AJ, Aldridge SC, Cohen G, Ball DS, Pliskin M, White JV. A strategy of aggressive regional therapy for acute iliofemoral venous thrombosis with contemporary venous thrombectomy or cateter-directed thrombolysis. J Vasc Surg 1994;20:244-254   DOI   ScienceOn
4 Semb CP, Dake MD. Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis. Radiology 1994; 191:487-494   DOI
5 O'Sullivan GJ, Semba CP, Bittner CA, Kee ST, Razavi MK, Sze DY, et al. Endovascular management of iliac vein compression (May- Thurner) syndrome. J Vasc Interv Radiol 2000;11:823-826   DOI   ScienceOn
6 Kwak HS, Han YM, Lee YS, Jin GY, Chung GH. Stents in common iliac vein obstruction with acute ipsilateral deep vein thrombosis: early and late results. J Vasc Interv Radiol 2005;16:815-822   DOI   ScienceOn
7 Patel NH, Stookey KR, Ketcham DB, Cragg AH. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome. J Vasc Interv Radiol 2000; 11:1297-1302   DOI   ScienceOn
8 Vedantham S, Vesely TM, Sicard GA, Brown D, Rubin B, Sanchez LA, et al. Pharmacomechanical thrombolysis and early stent placement for iliofemoral deep vein thrombosis. J Vasc Interv Radiol 2004;15:565-574   DOI   ScienceOn
9 Kim HS, Patra A, Paxton BE, Khan J, Streiff M. Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis: clinical and economic outcomes. J Vasc Interv Radiol 2006;17:1099-1104   DOI   ScienceOn
10 Kasirajan K, Gray B, Ouriel K. Percutaneous angioJet thrombectomy in the management of extensive deep venous thrombosis. J Vasc Interv Radiol 2001;12:179-185   DOI   ScienceOn
11 Vedantham S, Vesely TM, Parti N, Darcy M, Hovseian DM, Picus D. Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy. J Vasc Interv Radiol 2002;13:1001-1008   DOI   ScienceOn
12 Lin PH, Zhou W, Dardik A, Mussa F, Kougias P, Hedayati N, et al. Catheter-directed thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg 2006;19:782-788
13 Jaffe JW, Newcomb JA, York T, Matulewicz TJ. Venous valvular assessment after retrograde catheterization. J Vasc Intev Radiol 1996;7:595-597   DOI   ScienceOn
14 Armon MP, Whitaker SC, Tennant WG. Catheter-directed thrombolysis of iliofemoral deep vein thrombosis. A new approach via the posterior tibial vein. Eur J Endovasc Surg 1997;13:413-416   DOI   ScienceOn
15 Enden T, Sandvik L, Klow N, Hafsahl G, Holme PA, Holmen LO, et al. Catheter-directed venous thrombolysis in acute iliofemoral vein thrombosis-the CaVenT study: rationale and design of a multicenter, randomized, controlled, clinical trial. Am Heart J 2007;154:808-814   DOI   ScienceOn
16 O'Sullivan G, Lohan DG, Gough N, Cronin CG, Kee ST. Pharmacomechanical thrombectomy of acute deep vein thrombosis with the Trellis-8 isolated thrombolysis catheter. J Vasc Interv Radiol 2007;18:715-724   DOI   ScienceOn
17 Kolbel T, Lindh M, Holst J, Uher P, Eriksson KF, Sonesson B, et al. Extensive acute deep vein thrombosis of the iliocaval segment: midterm results of thrombolysis and stent placement. J Vasc Interv Radiol 2007;18:243-50   DOI   ScienceOn
18 Elsharawy M, Elzayat E. Early results of thrombolysis vs anticoagulation in ilofemoral venous thrombosis: a randomized clinical trial. Eur J Vasc Endovasc Surg 2002;24:209-214   DOI   ScienceOn
19 Watson LI, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Library 2005;1:1-66
20 Wells PS, Forster AJ. Thrombolysis in deep vein thrombosis: is there still an indication. Thromb Haemost 2001;86:499-508
21 Mewissen WM, Seabrook GR, Meissner MH, Cynamn J, Labroonlos N, Haughton SH, et al. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of national multicenter registry. Radiology 1999;211:39-49   DOI
22 McLennan G, Trerotola SO, Davidson E, Rhodes CA, Lazzaro C, Dreesen J, et al. The effects of a mechanical thrombolytic device on normal canine vein valves. J Vasc Interv Radiol 2001;12:89-94   DOI   ScienceOn
23 Roy S, Laerum F. Transcatheter aspiration: the key to successful percutaneous treatment of deep venous thrombosis? Acad Radiol 1999;6:730-735   DOI   ScienceOn
24 Sharafuddin MJ, Gu X, Han YM, Urness M, Gunther R, Amplatz K. Injury potential to venous valve from the Amplatz thrombectomy device. J Vasc Interv Radiol 1999;10:64-69   DOI   ScienceOn
25 Polak JF. Peripheral vascular sonography: a practical guide, 2nd ed. Philadelphia: Lippincott Williams and Wilkins, 2004:168-220