Recently data have emerged suggesting that patients with DVT benefit significantly from mechanical removal of the thrombosis. In the past, surgical treatment has yielded relatively poor longterm results. However, with the advent of mechanical/ thrombolytic devices, long-term CVH can be reduced to the 10 percent range. Currently available through the interventional radiology department at Martha Jefferson Hospital is the Trellis-8 device, a percutaneous FDA-approved system designed to isolate thrombus and allow directed mechanical and thrombolytic removal of a DVT. The device works by percutaneous insertion into the affected vein with balloon isolation above and below the thrombus. An oscillatory mechanical wire thrombectomy is performed and local lytic therapy administered. This device allows for shorter lytic infusion, reduced lytic infusion, and safe removal of the thrombus with preservation of vein valve integrity. The long-term results related have revealed marked improvement in the reduction of CVH.
Following diagnosis of her DVT thrombosis, Ms. Fae's right leg deep venous thrombosis was successfully treated with the Trellis-8 device as an outpatient procedure. She was able to stand and walk without pain or discomfort soon after the procedure. A follow-up duplex ultrasound six months later demonstrated no evidence of residual obstructive thrombus with normal valvular function, and Ms. Fae had no residual leg symptoms. New recommendations and guidelines for early pharmacomechanical treatment of DVT have been embraced by the American College of Chest Physicians and National Quality Forum.