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:
GREAT CASE WITH A TERRIFIC RESULT!
I THINK THAT MOST WOULD AGREE THAT RE-ESTABLISHMENT OF FLOW THROUGH THE THROMBOSED SEGMENT OF VEIN IS VITALLY IMPORTANT FOR A SUCCESSFUL OUTCOME. FOR THAT REASON, I THINK MECHANICAL DEVICES ARE VERY USEFUL SINCE THEY CAN ACHIEVE THIS RAPIDLY. OF COURSE, THERE ARE NO TRIALS TO SUPPORT THIS.
I'M NOT SURE WHICH DEVICE IS BEST, BUT I KNOW WHAT DOESN'T WORK. THE 6F AMPLATZ IS PRETTY MUCH WORTHLESS. THE ACTIVATION TIMES ARE VERY LONG AND THE AREA OF EFFECTIVE THROMBUS PULVERIZATION IS NOTICEABLY SMALLER THAN THE 8F.
RE: FILTER USE. I HUMBLY REFER YOU TO OUR ARTICLE IN JVIR (NOV-DEC 1997 VOLUME 8:1005-1010). JAN DURHAM AND I GRAPPLE WITH THE SAME ISSUES IN A VERY SIMILAR CASE. DR COPE HAS DESCRIBED THE NOVEL USE OF BIRD'S NEST FILTER AS A TEMPORARY DEVICE (RADIOLOGY 1996 198:765-767). UNFORTUNATELY, THE CHOICES ARE LIMITED WITH THE BIG KIBOSH [SIC] ON THE TEMPOFILTER. AT THE RECENT SCVIR MEETING, I WAS SUPRISED AT THE LACK OF CONCERN RE: PE IN PATIENT'S WITH CAVAL THROMBUS. I ALSO REFER YOU TO AN INTERESTING ARTICLE BY RADOMSKI (AM SURG 1987 57:97-101) WHERE HE ATTEMPTED TO CATAGORIZE IVC THROMBUS WITH REGARDS TO PE RISK. SMALL NUMBERS PREVENT CONCLUSION, HOWEVER.
I HAVE SOME RESERVATIONS ABOUT PUTTING AN 8F SHEATH IN THE POPLITEAL VEIN, ALTHOUGH THERE IS NO EMPIRIC DATA TO COMFIRM MY PARANOIA, THAT I'M AWARE OF. DOES ANYONE ELSE SHARE MY CONCERN?