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Acta Phlebologica 2017 April;18(1):12-6

DOI: 10.23736/S1593-232X.17.00374-5

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Prevention of post-thrombotic syndrome: role of fibrinolysis in proximal deep vein thrombosis

Tiberio ROCCA 1, Andrea MANFRINI 1, Luca TRAINA 1, Pierfilippo ACCIARRI 1, Vincenzo GASBARRO 1, 2, 3

1 Vascular Surgery Unit, S. Anna Hospital, Ferrara, Italy; 2 Mathematics for Technology and Medicine Research Center, University of Ferrara, Ferrara, Italy; 3 International Research and Educational Program in Clinical and Experimental Biotechnology, Interuniversity Center of Education and Research in Phlebology, University of Ferrara, Ferrara, Italy


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BACKGROUND: Deep vein thrombosis (DVT) of the lower limbs is a relatively common clinical condition, with an incidence estimated at 1-2 cases per 1000 inhabitants per year. Post-thrombotic syndrome (PTS) is a chronic complication which particularly affects patients with proximal DVT (ilio-femoral); it significantly impacts upon patients’ quality of life and it also has major health-economic implications.
METHODS: We report our experience with ultrasound accelerated thrombolysis EKOS system in treatment of patients affected by proximal DVT.
RESULTS: In our experience, we treated three cases of proximal DVT adopting ultrasound accelerated thrombolysis with EKOS system. Technical success rate was 100% in absence of embolic or hemorrhagic complications. The mean follow-up was 18 months: there were no thrombotic recurrences and none of the three patients had clinical signs of PTS. Loco-regional thrombolysis applied in selected cases of proximal DVT, unlike traditional therapy with oral anticoagulants, is able to ensure a rapid resolution of the thrombotic process, thus limiting valvular damage, that underlies the development of PTS. In recent years new techniques like mechanical, pharmaco-mechanical and ultrasound enhanced thrombolysis were developed. They allow a further reduction in both duration of treatment and drugs dose used, compared to pharmacological thrombolysis alone and also lead to an overall costs’ reduction.
CONCLUSIONS: In conclusion, from both a review of the literature and our own experience, pharmacological thrombolysis has proven to be a safe and effective technique in the treatment of proximal DVT, in order to prevent the development of PTS; nevertheless, it appears appropriate that those techniques are reserved to highly selected patients and practiced in centers with adequate experience and resources.


KEY WORDS: Lower extremity deep vein thrombosis - Postthrombotic syndrome - Thrombolytic therapy

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