Casella Ivan Benaduce, Presti Calógero, Aun Ricardo, Benabou Joseph Elias, Puech-Leão Pedro
Division of Vascular Surgery, Medical School, São Paulo University, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2007 Feb;62(1):31-40. doi: 10.1590/s1807-59322007000100006.
To evaluate the efficacy of catheter-directed low-dose recombinant tissue-type plasminogen activator infusion in the treatment of iliofemoral deep venous thrombosis and prevention of post-thrombotic syndrome.
Eighteen patients (out of 260 evaluated) with acute iliofemoral deep venous thrombosis and no previous evidence of venous insufficiency were prospectively selected for thrombolytic therapy. Catheter-directed low-dose recombinant tissue-type plasminogen activator (1 mg/h) was infused into the thrombotic segments.
Effective fibrinolysis was achieved in 14 of 18 cases, with correlation between effective fibrinolysis and major/complete resolution of acute signs and symptoms (P <.01). There were no episodes of major complications. Four patients presented with early rethrombosis (1 to 8 weeks). Individuals were followed for a period up to 131 weeks (average, 85.2). The incidence of clinical signs and symptoms of venous insufficiency and duplex-scan findings of valvular reflux was significantly lower in the patients in which lytic therapy succeeded and patency was kept, compared with patients experiencing acute therapeutic failure or rethrombosis (P <.01).
Low-dose recombinant tissue-type plasminogen activator fibrinolytic therapy is safe and effective in the treatment of acute iliofemoral venous thrombosis. The late evolution as revealed clinically and by ultrasound was superior in patients for whom lytic therapy was effective.
评估导管定向低剂量重组组织型纤溶酶原激活剂输注治疗髂股深静脉血栓形成及预防血栓形成后综合征的疗效。
前瞻性选择18例（在260例评估患者中）急性髂股深静脉血栓形成且既往无静脉功能不全证据的患者进行溶栓治疗。将导管定向低剂量重组组织型纤溶酶原激活剂（1毫克/小时）注入血栓形成段。
18例中有14例实现有效纤溶，有效纤溶与急性体征和症状的主要/完全缓解之间存在相关性（P<.01）。无重大并发症发生。4例患者出现早期再血栓形成（1至8周）。对患者进行了长达131周（平均85.2周）的随访。与急性治疗失败或再血栓形成的患者相比，溶栓治疗成功且保持通畅的患者中静脉功能不全的临床体征和症状发生率以及瓣膜反流的双功超声检查结果明显更低（P<.01）。
低剂量重组组织型纤溶酶原激活剂溶栓治疗急性髂股静脉血栓形成安全有效。溶栓治疗有效的患者在临床和超声检查中显示的后期演变情况更佳。
