IF10. Catheter-Directed Thrombolysis of Acute Entire Limb Deep Vein Thrombosis With Below-the-Knee Access: A Retrospective Analysis From a Single Center

Abstract

Catheter-directed thrombolysis (CDT) for deep vein thrombosis (DVT) was a rapid and efficient method to eradicate thrombus and has been confirmed to reduce the development of post-thrombotic syndrome (PTS). The popliteal or femoral vein approach is the most common venous access for CDT; however, when the thrombosis involved with crural or popliteal vein, these approaches may not be appropriate. This study was performed to evaluate the safety and effectiveness of below-the-knee (BTK) access in the treatment of entire limb deep vein thrombosis. Retrospective analysis of a collected database of consecutive CDT treatment of acute lower limb deep vein thrombosis with the BTK access (2009-2015). A consecutive series of 78 patients (51 men), mean age, 53 years (range, 27-70) with first-time DVT were retrospectively analyzed. All of the patients were symptomatic. Early efficacy was assessed with a thrombus score based on venography. Latest and 2-year follow-up included popliteal and iliofemoral patency assessed with duplex ultrasound or venography, and PTS was assessed with the Villalta scale. Lysis was successful (ie, >50%) in 78 cases of entire-limb DVT. CDT was performed by accessing the ipsilateral small saphenous vein, posterior tibial vein, and popliteal join point (27 via incision, 61 via puncture guided by ultrasound or fluoroscopy). Of 16 total bleeding complications, none were classified as major, and 11 were related to the site of incision in the small saphenous or posterior tibial vein, causing lower leg numbness. Poor wound healing occurred in one case. At the latest follow-up, the patency was 87.09% (54 of 62). During the 24-month follow-up, the patency 80.43% (37 of 46) and the PTS rate was 32.61% (15 of 46). Further, the time between symptom onset and lysis was inversely correlated with the Villalta score (P < .05). Timely CDT after DVT symptom onset reduces the incidence of PTS. BTK access is an appropriate selection to entire-limb DVT, with safety and efficacy.