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Abstract No. 1: Safety of Catheter-Directed Thrombolysis for Deep Venous Thrombosis in Patients with Cancer
10:00 AM
Abstract No. 1
Safety of Catheter-Directed Thrombolysis for Deep Venous Thrombosis in Patients with Cancer. S.R. Preece, J.H. Black, M.B. Streiff, L.D. Pham, H.S. Kim; Johns Hopkins School of Medicine, Baltimore, MD PURPOSE: Catheter-Directed Thrombolysis (CDT) is a therapy shown to result in rapid reduction of thrombus burden and improve symptoms in deep venous thrombosis (DVT). However, its use in cancer patients is limited due to potential for greater risk of complications. The purpose of this study is to assess the safety and of CDT for upper and lower extremity DVT in patients with cancer. MATERIALS AND METHODS: Consecutive patients with acute ilio-femoral or brachio-subclavian DVT treated with CDT between 1995 and 2007 were identified. Demographics and clinical outcomes were compared between patients with cancer and without cancer. RESULTS: 202 limbs in 178 patients (75 limbs in 61 cancer patients and 127 limbs in 117 noncancer patients) were treated with CDT. The mean treatment duration for patients with (29.7 ⫾ 21.2 hours) and without cancer (28.8 ⫾ 22.2 hours) was similar (p⫽0.7774), as was rate of previous DVT (46.7% in cancer patients vs. 52.0% in noncancer) (p⫽0.4666). Three cancer patients (4.9%) and four noncancer patients (3.4%) suffered major bleeding during CDT (p⫽0.6924). Four cancer (6.6%) and six non-cancer patients (5.1%) suffered from minor bleeding during CDT (p⫽0.7376). Pulmonary embolism occurred in 1 of 61 cancer patients (1.6%) and 2 of 117 patients without cancer (1.7%) (p⫽0.9999) during CDT. Age, sex, prior DVT, and the type of cancer were all insignificant variables in determining who suffered from bleeding complications. CONCLUSION: Percutaneous CDT is safe for cancer patients and patients without cancer suffering from acute symptomatic DVT. The presence of cancer should not discourage clinicians from considering catheter directed therapy for appropriately selected patients. 10:12 AM
Abstract No. 2
Effect of Flowrate on Hemolysis during Use of the OmniSonics OmniWave™ Endovascular System and the Possis AngioJet®. E.V. Lang,1,2 S.R. Gladstone,1 R.M. Balano,1 W. Barnhart,1 T.E. Higgins,1 M. Crippa,1 A.M. Kulis;1 1OmniSonics Medical Technologies, Wilmington, MA; 2Beth Israel Deaconess Medical Center, Boston, MA PURPOSE: Assess the effect of flow rate on hemolysis during use of the OmniSonics OmniWaveTM Endovascular System and Possis AngioJet® connected to a DVX® catheter. MATERIALS AND METHODS: In vitro experiments were performed in a flow circuit with tubing diameters from 6-12
RESULTS: At lower linear velocities the devices lysed more RBC/mL in the treatment zone, but the overall effect was negligible in contrast to the effects of volume flow. The total amount of PfHgb increased significantly with volume flow (p ⬍ 0.005) for both devices. The OmniWave produced significantly less PfHgb (p ⬍ 0.001). The AngioJet was more susceptible to changes in flow and diameter (p-Interaction ⬍ 0.001). Total PfHgb after 1 min measured 5951,050 mg for the OmniWave and 4,847-13,160 mg for the Angiojet. With increasing volume flow the hematocrit of the fluid in the AngioJet collection bag increased from 6-13% (R-squared 0.903). In vivo experiments confirmed a significant reduction of mean PfHgb generation from 23 mg/dL per min under free flow to 9 mg/dL per min under reduced flow conditions (p⫽0.002). CONCLUSION: Hemolysis increases significantly with increasing flow for both devices. The OmniWave produces considerably less hemolysis than the AngioJet with the difference increasing with higher flow rates. With increasing volume flow the AngioJet removes increasingly larger amounts of red blood cells. These findings may have implications in settings of reperfusion after thrombectomy or during treatment of non-occlusive clot. 10:24 AM
Abstract No. 3
The Use of Adjunctive Percutaneous Mechanical Thrombectomy for Iliofemoral Deep Venous Thrombosis in Cancer Patients. S.R. Preece, J.H. Black, M.B. Streiff, H.S. Kim; Johns Hopkins School of Medicine, Baltimore, MD PURPOSE: The purpose of this study is to assess the clinical benefits of adjunctive percutaneous mechanical thrombectomy with catheter-directed thrombolysis (CDT) for iliofemoral deep vein thrombosis (DVT) in patients with cancer. MATERIALS AND METHODS: Consecutive cancer patients with acute ilio-femoral DVT treated with CDT alone and CDT with PMT between 1995 and 2007 were identified. Demographic characteristics and clinical outcomes were compared between patients with CDT alone vs. CDT ⫹ PMT. RESULTS: Fifty-four limbs in 42 patients with cancer were treated with CDT. Fourteen limbs in 12 patients received CDT alone while 40 limbs in 30 patients were treated with CDT ⫹ PMT. Mean treatment duration for CDT was 46.8 ⫾ 23.3 hours compared with 26.1 ⫾ 18.2 hours for CDT ⫹ PMT (p⫽0.0013). CDT achieved complete clot lysis in 78.6% (11/14 limbs) compared with 65.0% (26/40 limbs) for CDT ⫹ PMT (p⫽0.5073). The incidence of major or minor bleeding (CDT, 16.7% versus CDT ⫹ PMT, 23.3%; p⫽0.7070) and pulmonary embolism (CDT, 8.3% versus CDT ⫹ PMT, 0%; p⫽0.2857) were similar. Long-
S3
SUNDAY
Sunday, March 16, 2008 10:00 AM - 12:00 PM Room: 204A
mm, volume flow rates of 3-12.5 mL/sec and linear flow velocities from 0.11-0.31 cm/sec. Fresh ACD anticoagulated bovine blood was used for each test, which consisted of a single 1-min pass during device activation. Hematocrit and plasma free hemoglobin (PfHgb) were assessed before and after passage of blood, as well as in the fluid in the collection bag of the AngioJet. Additionally, an in vivo study with the OmniWave was performed to test the assumptions gained in vitro. The ileofemoral vessels of 12 Yorskhire pigs, weighing 64-88 kg, were treated: half under free flow and half with flow reduced. Analyses within and across groups were compared by ANOVA and regression analyses at a significance level of p ⬍ 0.05.
Scientific Sessions
Scientific Session 1 Venous Thromboembolic Disease, Lysis
Abstract No. 1
Safety of Catheter-Directed Thrombolysis for Deep Venous Thrombosis in Patients with Cancer. S.R. Preece, J.H. Black, M.B. Streiff, L.D. Pham, H.S. Kim; Johns Hopkins School of Medicine, Baltimore, MD PURPOSE: Catheter-Directed Thrombolysis (CDT) is a therapy shown to result in rapid reduction of thrombus burden and improve symptoms in deep venous thrombosis (DVT). However, its use in cancer patients is limited due to potential for greater risk of complications. The purpose of this study is to assess the safety and of CDT for upper and lower extremity DVT in patients with cancer. MATERIALS AND METHODS: Consecutive patients with acute ilio-femoral or brachio-subclavian DVT treated with CDT between 1995 and 2007 were identified. Demographics and clinical outcomes were compared between patients with cancer and without cancer. RESULTS: 202 limbs in 178 patients (75 limbs in 61 cancer patients and 127 limbs in 117 noncancer patients) were treated with CDT. The mean treatment duration for patients with (29.7 ⫾ 21.2 hours) and without cancer (28.8 ⫾ 22.2 hours) was similar (p⫽0.7774), as was rate of previous DVT (46.7% in cancer patients vs. 52.0% in noncancer) (p⫽0.4666). Three cancer patients (4.9%) and four noncancer patients (3.4%) suffered major bleeding during CDT (p⫽0.6924). Four cancer (6.6%) and six non-cancer patients (5.1%) suffered from minor bleeding during CDT (p⫽0.7376). Pulmonary embolism occurred in 1 of 61 cancer patients (1.6%) and 2 of 117 patients without cancer (1.7%) (p⫽0.9999) during CDT. Age, sex, prior DVT, and the type of cancer were all insignificant variables in determining who suffered from bleeding complications. CONCLUSION: Percutaneous CDT is safe for cancer patients and patients without cancer suffering from acute symptomatic DVT. The presence of cancer should not discourage clinicians from considering catheter directed therapy for appropriately selected patients. 10:12 AM
Abstract No. 2
Effect of Flowrate on Hemolysis during Use of the OmniSonics OmniWave™ Endovascular System and the Possis AngioJet®. E.V. Lang,1,2 S.R. Gladstone,1 R.M. Balano,1 W. Barnhart,1 T.E. Higgins,1 M. Crippa,1 A.M. Kulis;1 1OmniSonics Medical Technologies, Wilmington, MA; 2Beth Israel Deaconess Medical Center, Boston, MA PURPOSE: Assess the effect of flow rate on hemolysis during use of the OmniSonics OmniWaveTM Endovascular System and Possis AngioJet® connected to a DVX® catheter. MATERIALS AND METHODS: In vitro experiments were performed in a flow circuit with tubing diameters from 6-12
RESULTS: At lower linear velocities the devices lysed more RBC/mL in the treatment zone, but the overall effect was negligible in contrast to the effects of volume flow. The total amount of PfHgb increased significantly with volume flow (p ⬍ 0.005) for both devices. The OmniWave produced significantly less PfHgb (p ⬍ 0.001). The AngioJet was more susceptible to changes in flow and diameter (p-Interaction ⬍ 0.001). Total PfHgb after 1 min measured 5951,050 mg for the OmniWave and 4,847-13,160 mg for the Angiojet. With increasing volume flow the hematocrit of the fluid in the AngioJet collection bag increased from 6-13% (R-squared 0.903). In vivo experiments confirmed a significant reduction of mean PfHgb generation from 23 mg/dL per min under free flow to 9 mg/dL per min under reduced flow conditions (p⫽0.002). CONCLUSION: Hemolysis increases significantly with increasing flow for both devices. The OmniWave produces considerably less hemolysis than the AngioJet with the difference increasing with higher flow rates. With increasing volume flow the AngioJet removes increasingly larger amounts of red blood cells. These findings may have implications in settings of reperfusion after thrombectomy or during treatment of non-occlusive clot. 10:24 AM
Abstract No. 3
The Use of Adjunctive Percutaneous Mechanical Thrombectomy for Iliofemoral Deep Venous Thrombosis in Cancer Patients. S.R. Preece, J.H. Black, M.B. Streiff, H.S. Kim; Johns Hopkins School of Medicine, Baltimore, MD PURPOSE: The purpose of this study is to assess the clinical benefits of adjunctive percutaneous mechanical thrombectomy with catheter-directed thrombolysis (CDT) for iliofemoral deep vein thrombosis (DVT) in patients with cancer. MATERIALS AND METHODS: Consecutive cancer patients with acute ilio-femoral DVT treated with CDT alone and CDT with PMT between 1995 and 2007 were identified. Demographic characteristics and clinical outcomes were compared between patients with CDT alone vs. CDT ⫹ PMT. RESULTS: Fifty-four limbs in 42 patients with cancer were treated with CDT. Fourteen limbs in 12 patients received CDT alone while 40 limbs in 30 patients were treated with CDT ⫹ PMT. Mean treatment duration for CDT was 46.8 ⫾ 23.3 hours compared with 26.1 ⫾ 18.2 hours for CDT ⫹ PMT (p⫽0.0013). CDT achieved complete clot lysis in 78.6% (11/14 limbs) compared with 65.0% (26/40 limbs) for CDT ⫹ PMT (p⫽0.5073). The incidence of major or minor bleeding (CDT, 16.7% versus CDT ⫹ PMT, 23.3%; p⫽0.7070) and pulmonary embolism (CDT, 8.3% versus CDT ⫹ PMT, 0%; p⫽0.2857) were similar. Long-
S3
SUNDAY
Sunday, March 16, 2008 10:00 AM - 12:00 PM Room: 204A
mm, volume flow rates of 3-12.5 mL/sec and linear flow velocities from 0.11-0.31 cm/sec. Fresh ACD anticoagulated bovine blood was used for each test, which consisted of a single 1-min pass during device activation. Hematocrit and plasma free hemoglobin (PfHgb) were assessed before and after passage of blood, as well as in the fluid in the collection bag of the AngioJet. Additionally, an in vivo study with the OmniWave was performed to test the assumptions gained in vitro. The ileofemoral vessels of 12 Yorskhire pigs, weighing 64-88 kg, were treated: half under free flow and half with flow reduced. Analyses within and across groups were compared by ANOVA and regression analyses at a significance level of p ⬍ 0.05.
Scientific Sessions
Scientific Session 1 Venous Thromboembolic Disease, Lysis