Upper Extremity DVT

Physicians

Charles S. Thompson, M.D.
Michael J. Cohen, M.D.
Jon M. Wesley, M.D. and
Aubrey Willard, ARNP
Vascular Specialists of Central Florida

Background

A 45 year old female was admitted to the hospital after traumatic injury from a motor vehicle accident. During the course of her hospitalization she developed a catheter-induced acute deep vein thrombosis (DVT) of the right upper extremity. Her right arm was severely edematous and painful with palpable pulses. The patient had an active GI bleed and was therefore not a candidate for systemic anticoagulation.

Procedure

A venogram was performed in the endovascular suite and there appeared to be acute clot extending from the brachial vein, axillary vein, and subclavian vein, up to the level of the innominate vein (Figure 1).

A Trellis®-8 Peripheral Infusion System was placed and 15mg of t-PA was infused for a total of 30 minutes. The Trellis effectively cleared the clot.

Venography showed complete resolution of the clot. Balloon angioplasty was then performed on the residual stenosis with a 10mm x 6mm then 12mm x 6mm dilation catheter. An excellent result was obtained and there was no residual clot seen throughout the entire venous system (Figure 2).

Conclusion

The patient tolerated the procedure well and on examination the following day her right arm was non-edematous and the pain subsided. The patient was discharged without the need for long term anticoagulation or the sequelae of postthrombotic syndrome, a potentially chronic complication of DVT.

Pharmacomechanical thrombolysis with angioplasty is an effective alternative to systemic anticoagulation in the treatment of DVT. The procedure is simple and straightforward. The Trellis-8 catheter is a device which mechanically isolates the clot and dissolves the thrombus with a small amount of lytic agent.

As an alternative to anticoagulation, the treatment results in immediate resolution of clot and symptoms. The procedure is underutilized due to the lack of knowledge of its availability and reliance on noninvasive therapies for venous thrombosis treatments. The hallmark of success of the procedure is early diagnosis and treatment, since venous thrombosis older than three weeks cannot be predictably lysed in this manner.