Abstract
ObjectiveThe aim of the study was to discuss the results of catheter-directed thrombolysis and complementary procedures to treat acute iliofemoral deep vein thrombosis (DVT) evaluating the safety and effectivness of an easy access such as the Great Saphenous Vein.Methods and materialsA total of 22 consecutive patients with iliofemoral thrombosis and two patients with femoro-popliteal thrombosis on recent onset diagnosed with Ultrasound Doppler and contrast venography underwent intrathrombus drip infusion of urokinase while intravenous heparin was continued using saphenical access. Residual venous stenosis were treated in six patients by percutaneous balloon Angioplasty and stenting. All patients underwent routine venous duplex imaging at 30 days, 3 months, 6 months and every 6 months thereafter.ResultsComplete patency of thrombosed veins was restored in 22 patients (91 %) with prompt symptomatic relief. There were no major complications in the immediate outcomes. At follow-up, two patients reported a persistant slim iliac vein stenosis, two patients had post-thrombotic syndrome, and two patients showed Deep Vein Reflux.ConclusionLocal thrombolysis using saphenical access was a safe and effective approach for the treatment of acute iliofemoral deep vein thrombosis. It seems to be a valid, easy and safe alternative, reducing the risks of haematoma and venous lesions, which can be observed when using femoral, popliteal, and trans-jugular access.
Highlights
Ilio-femoral deep vein thrombosis (DVT) treated with conventional therapy have showed to severly compromised muscle pump function and valvular competency at 5 years follow-up despite improvement in venous outflow and only 6 % of patients with acute proximal DVT had complete lysis of the thrombus within 10 days [1, 2]
Even if no general consensus exist on the optimal treatment for DVT [17], thrombolytic therapy is faster than standard therapies such as heparin and warfarin and can produce better results because the medication is directional to the clot permitting the resolution of the symptoms, preventing PTS and decreasing the risk of pulmonary embolism (PE) [18]
Bättler et al demonstrated that local thrombolysis, applied under ischemic conditions combined with surgical thrombectomy is easy to perform, vein patency and valve function are restored and post thrombotic syndrome is prevented [19]
Summary
Ilio-femoral deep vein thrombosis (DVT) treated with conventional therapy have showed to severly compromised muscle pump function and valvular competency at 5 years follow-up despite improvement in venous outflow and only 6 % of patients with acute proximal DVT had complete lysis of the thrombus within 10 days [1, 2]. Catheter-directed thrombolysis with angioplasty and stenting when needed can be done using femoral, jugular, pedal veins access [3, 5] but can result difficult for some patients such as politraumatic or neoplastic patients or patient who complicated after surgery. The objective of this study was to see if saphenous vein could be an alternative access for locoregional thrombolysis in complicated patients. We will describe the results obtained after 2 years follow-up in 24 patients who underwent catheter-directed thrombolysis using an original access such as the Great Saphenous Vein (GSV).
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