Iliofemoral Deep Venous Thrombosis: Safety and Efficacy Outcome during 5 Years of Catheter-directed Thrombolytic Therapy

Abstract

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