Mohsen Sharifi, adjunct associate professor of Medicine at A T Still University, Mesa, USA, presented new data demonstrating that percutaneous endovenous intervention (PEVI) is an alternative in the treatment of upper extremity deep vein thrombosis at the iCON meeting in Arizona, USA. Previous studies by Sharifi’s group had demonstrated a successful performance with PEVI in lower extremity deep vein thrombosis.
“PEVI is an effective tool in the treatment of deep vein thrombosis of the lower extremities. There is relatively less data on the outcome of PEVI for upper extremity deep vein thrombosis. The purpose of this study was to evaluate the outcome of PEVI in patients with symptomatic upper extremity deep vein thrombosis,” Sharifi stated.
“A total of 35 patients with upper extremity deep vein thrombosis underwent PEVI by our group,” he noted. PEVI, he explained, consisted of a combination of thrombectomy with either Trellis (Bacchus Vascular) or Angiojet (Possis Medical), balloon venoplasty, placement of an infusion catheter with thrombolysis or stenting. Access was obtained through the brachial or internal jugular vein under ultrasound guidance. The objective was to establish streamline flow from the access site into the superior vena cava.
Procedural success was achieved in 34/35 patients (95%) with substantial improvement or resolution of clinical symptoms. The primary aetiology of upper extremity deep vein thrombosis were: indwelling central catheters in 16, pacemaker or defibrillator leads in eight, cancer in three, hypercoagulable state not related to cancer in four, venous thoracic outlet syndrome in one, and unknown in three patients.
Concomitant deep vein thrombosis at other sites was found in eight patients (23%). At the time of PEVI, 32 patients (91%) were already on anticoagulation.
The venographic appearance in the majority of patients was that of acute deep vein thrombosis superimposed on a venosclerotic and scarred venous bed suggesting repeated previous insults. There were no procedural deaths or major bleeding.
Sharifi said that “the results indicate that PEVI is highly effective and safe in the treatment of upper extremity deep vein thrombosis.” He also noted that there appears to be a major shift in the aetiology of this disease with more benign entities surpassing malignant causes.