Catheter-Directed Thrombolysis of Iliofemoral Deep Vein Thrombosis Reduces Deep Vein Thrombosis Recurrence

Abstract

Iliofemoral deep vein thrombosis (DVT) is a result of a major thrombotic stimulus that results in substantial postthrombotic morbidity in patients treated with anticoagulation alone. It has been shown that iliofemoral DVT is a powerful and independent risk factor for recurrent thromboembolism. Furthermore, recurrent DVT escalates postthrombotic morbidity, since recurrent DVT has been correlated with residual venous thrombus. Eliminating thrombus in high-risk patients might reduce the risk of recurrence. We reviewed the entire cohort of patients with iliofemoral DVT treated with catheter-directed thrombolysis to determine their risk of recurrence and whether there was a relationship to lytic success. All patients who underwent catheter-based thrombus removal for iliofemoral DVT had their degree of lysis assessed by comparison of pre- and postprocedural phlebography and were classified according to the percentage of residual thrombus. Recurrence was defined as a symptomatic presentation with image verification of new or additional thrombus. Sixty-two patients underwent catheter-directed thrombolysis for iliofemoral DVT. Mean age was 45 ± 17 years (range, 16-79 years), and 35 patients (56%) were male. Mean follow-up was 18.9 months and seven patients (11%) were lost to follow up. Forty-eight patients (87%) had no recurrence, and seven patients (13%) developed recurrent DVT. Recurrence developed in 67% of patients who had >60% residual thrombus but occurred in 10% of those who had <60% residual thrombus (P = .0253). The seven patients who developed recurrent DVT were anticoagulated at the time of recurrence. Patients who underwent either catheter-directed thrombolysis of iliofemoral DVT have lower incidence of recurrent deep vein thrombosis as compared with historic groups who are treated by anticoagulation alone. Furthermore, there is a direct correlation between the amount of residual thrombus following catheter-based thrombolysis and recurrence. As lytic success improves, the risk of recurrent DVT decreases. These data raise the hypothesis that successful thrombolysis reduces recurrence rates, which requires validation in prospective studies.