Iliofemoral deep venous thrombosis: safety and efficacy outcome during 5 years of catheter-directed thrombolytic therapy

J Vasc Interv Radiol. May-Jun 1997;8(3):405-18. doi: 10.1016/s1051-0443(97)70581-5.

Abstract

Purpose: To prospectively evaluate the angiographic and clinical results of using catheter-directed thrombolytic therapy for the treatment of acute iliofemoral deep venous thrombosis (IFDVT).

Materials and methods: All consecutive patients with acute IFDVT referred for thrombolytic treatment from July 1990 to December 1995 were included in this clinical data analysis. Infusions of urokinase were administered via a multisidehole infusion catheter. Angioplasty, stent placement, mechanical thrombectomy, and other procedures were often performed in conjunction with the thrombolytic procedure.

Results: Seventy-seven patients and 87 limbs were treated. The overall technical success rate was 79%, and was 86% for iliac veins and 63% for femoral veins. The primary and secondary patency rates at 1 year were 63% and 78%, respectively, for the iliac veins, and 40% and 51%, respectively, for the femoral veins. Patients with malignant disease fared worse. Patients requiring stent placement appeared to have inferior outcomes. A previous history of DVT did not appear to affect the results. Bleeding requiring transfusion and hematomas were the major complications encountered. Pulmonary embolus was not a significant problem. Technical success rates were lower in patients who had had symptoms for more than 4 weeks compared to those who had a more recent onset of symptoms.

Conclusion: Current data suggest that catheter-directed thrombolytic therapy is safe and effective in achieving intermediate-term venous Patency. The long-term clinical benefits of this procedure remain, however, to be established.

MeSH terms

  • Angioplasty
  • Arteriovenous Shunt, Surgical
  • Female
  • Femoral Vein*
  • Humans
  • Iliac Vein*
  • Infusions, Intravenous / methods
  • Life Tables
  • Male
  • Middle Aged
  • Plasminogen Activators / administration & dosage
  • Plasminogen Activators / therapeutic use*
  • Prospective Studies
  • Risk Factors
  • Stents
  • Thrombectomy
  • Thrombolytic Therapy / methods*
  • Thrombosis / diagnosis
  • Thrombosis / drug therapy*
  • Thrombosis / therapy
  • Treatment Outcome
  • Urokinase-Type Plasminogen Activator / administration & dosage
  • Urokinase-Type Plasminogen Activator / therapeutic use*
  • Vascular Patency

Substances

  • Plasminogen Activators
  • Urokinase-Type Plasminogen Activator