In Reply to: Case 0498_06 -- Thrombectomy and thrombolysis of iliac veins and inferior vena cava posted by Editor on March 31, 1998 at 14:51:35:
I have no doubt there is a role for mechanical devices in DVT almost certianly in conjunction with UK. The mean UK dose i the registry is about 8 million units and mean procedure time 51 hours; if we can use devices to get the mean dose down to a couple million and mean time to 24 hours or less we'll be doing a lot more DVT lysis. issues to address are:
Hemolysis-important with some devices-don't exceed maximum run time or risk putting the patient in renal failure-then you can declot their graft...
Effluent volume- are we sucking a lot of blood out of these folks?
PE-will probably need to revisit prophylactic and/or temporary filters. PE in registry is <2% but could be increased with mechanical devices
Effects on valves and intima-intima is basically toast in DVT but valves may not be yet. More work meeded here
Over the wire-needed and soon to be (or already is) available with nearly all devices.
Oh yes, then the all-important question-are we actually doing these peoiple any good at all? We'll only answer that one with good long-term prospective randomized trials, sorely needed but not yet supported by Abbott and others-let's not lose sight of this in our zeal to use devices in DVT.