Regional hyperthermic fibrinolytic perfusion after unsuccessful venous thrombectomy of extensive deep venous thrombosis.

Abstract

Because of the dose-dependent increase in bleeding complications, the intraoperative administration of fibrinolytic agents is limited. This limitation impairs the efficacy of fibrinolytic therapy because low-dose fibrinolysis often fails in the treatment of complex deep venous thrombosis (DVT). The aim of this study was to investigate the efficacy and safety of intraoperative high-dose fibrinolytic therapy for extended DVT, which was performed with the regional hyperthermic fibrinolytic perfusion (RHFP) technique. From January 1993 to June 2001, in 53 patients with extended DVT, unsuccessful venous thrombectomy (recanalization, <50%) was followed by RHFP with 0.5 mg/kg of body weight of recombinant tissue plasminogen activator. The extent of thrombosis was documented before, during (after the surgical thrombectomy), and after (between postoperative days 2 and 5) surgery with phlebography and was quantified with the Marder score. Intraoperative and postoperative complications were recorded prospectively. After RHFP, a recanalization was achieved in 64 of 146 venous segments (43.8%) that were still occluded despite thrombectomy. Eighty-two segments (56.2%) remained occluded. Compared with the preoperative phlebography, 32 patients (60.3%) had a successful recanalization (>50%). Eleven patients (20.8%) showed minimal and 10 patients (18.9%) no recanalization. No lethal complications occurred. One patient (1.9%) had pulmonary embolism develop, and two patients (3.8%) had bleeding complications develop. With the intraoperative use of hyperthermia-assisted high-dose fibrinolysis, improvement of the results of mechanical thrombectomy of extended DVT was possible. The RHFP protected against systemic side effects of the fibrinolysis and show a high safety of application.