Aksiller ven trombozunda lokal t-PA infüzyon tedavisinin etkinliði

The efficacy of local t-PA infusion in the treatment of axillary vein thrombosis

BACKGROUND: We evaluated the results of local tissue plasminogen activator (t-PA) infusion in the treatment of axillary vein thrombosis. METHODS: Fourteen male patients (mean age 23±2 years) who presented with pain and swelling in the arm were diagnosed as having axillary vein thrombosis. Besides physical examination, diagnoses were made with the use of venous Doppler ultrasound, duplex scanning or venography. Complaints were localized in the right upper arm in 10 patients, and in the left upper arm in four patients. Time to presentation from the onset of complaints ranged 1-3 days, 3-7 days, 7-10 days, and 10-14 days in six, three, two, and three patients, respectively. Infusion of t-PA (0.25 mg/kg) was performed for one hour via a venous catheter inserted to the distal part of the brachial vein. Venous patency was evaluated using Doppler ultrasound and venography. RESULTS: Axillary vein was shown to be patent by venous Doppler ultrasound in eleven patients within a mean of 4.2 hours. Three patients who exhibited no improvement received another t-PA (0.05 mg/kg/h) infusion six hours after the initial treatment. Venous Doppler ultrasound showed almost complete patency of the lumen after six, seven, and 11 hours of the subsequent infusion, respectively. Following therapy, all the patients were administered prophylactic anti-aggregating treatment. On control examinations after three months, venous Doppler ultrasound and venography showed that the lumens were almost completely patent in 12 patients and two patients, respectively. No recurrences were detected. CONCLUSION: Fibrinolytic agents yield high efficacy in the treatment of axillary vein thrombosis.