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Catheter direct thrombolysis (CDT) and ultrasound-facilitated thrombolysis (UAT) are newer techniques that facilitate to dissolve thrombus in patients with deep vein thrombosis (DVT). We aimed to do a meta-analysis comparing the clinical outcomes between them.
Pub Med, Cochrane and Embase were searched for all the clinical data that directly compared CDT and UAT for acute DVT of lower veins. Primary outcomes included ≥ 50 % thrombus reduction and repeat target vessel thrombolysis. Secondary outcomes included major and minor bleedings, additional angioplasty (PTA+ stent) and mean days of hospital stay. We used Fixed or Random Effect analysis using the Cochrane Handbook of Systematic Reviews and RevMan 5.2 for statistical analysis.
A total of 4 clinical studies provided a total of 293 (CDT=147; UAT=146). There was a trend towards higher rates of ≥ 50 % thrombus reduction in the CDT group compared to UAT (88% vs. 80%; p=0.06) whereas there was a significant less recurrence thrombus in the UAT group compared to the CDT (9% vs. 10%, p=0.04). Secondary outcomes analysis showed significant less stents required after UAT compared to CDT (39% vs. 62%, p= 0.04). There was no difference between groups in terms of length of hospital stay, minor and major bleeding events.
Out analysis suggested that UAT not only requires significant less angioplasty with stents but also might be associated with better re-stenosis rates whereas CDT significantly offered better thrombus burden reduction. Complication rates were similar between both groups. Further randomized trials should be pursued.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention