The safety and clinical efficacy of catheter-directed thrombolysis with prolonged infusion of low dose urokinase for treatment of acute iliac-femoral venous thrombosis

Abstract

Objective To investigate the safety and clinical efficacy of catheter-directed thrombolysis(CDT) with prolonged infusion of low dose urokinasefor treatment of acute iliac-femoral vein thrombosis.Methods From January 2005 to March 2011,63 patients of unilateral acute iliac-femoral vein thrombosis were treated by CDT and followed up for more than 12 months.The complications during CDT,thrombus clearance ratio,time for CDT,dose of urokinase,degree of limb swelling and clinical follow-up data were retrospectively reviewed.The Fisher exact test was used for enumeration of data.The measurements of data were tested with the one-way analysis of variance and two-two comparison LSD test.Thrombus clearance ratio in different time frame was tested by repeated measurement of data and analysis of variance.Results During the CDT,no symptomatic pulmonary embolism (PE) and significant bleeding happened.Ten (15.9％) patients had complications of minor bleeding,including 3 patients with blood oozing along the edge of vascular sheath,3 patients with subcutaneous ecchymosis or hematoma around the puncture site,3 patients with hematuria and 1 patient with gums bleeding.In four (6.3％) patients,complications were caused by catheter placement,including 3 patients with soft tissue inflammation around puncture site and 1 patient with secondary thrombosis surrounding the vascular sheath.Fifty three patients (84.1％) achieved thrombolytic degree Ⅲ and Ⅱ at 4th to 8th day during CDT.Thrombus clearance ratio was higher in CDT with urokinase 500 000 U/d and 750 000 U/d than 250 000 U/d[(91.2 ± 10.1)％ vs (75.9±20.1)％,(91.3 ± 12.2)％ vs (75.9±20.1)％,all P ＜0.05].Thrombus clearance ratio showed no significant difference between CDT with urokinase 500 000 U/d and 750 000 U/d [(91.2 ±10.1) ％ vs (91.3 ± 12.2) ％,P ＞0.05].There was no significant difference between CDT with urokinase 500 000 U/d and 750 000 U/d in perfusion thrombolytic time to reach thrombolytic degree Ⅲ [(7.1 ± 1.0)vs (6.2±1.3)d,P＞0.05]and Ⅱ[(6.4±1.0) vs (6.0±0.8)d,P＞0.05].Thrombus clearance ratio increased along with an increase in thrombolytic time for CDT (P ＜ 0.05).After 24 hours of CDT,58 (92.1％) patients showed reduction of soft tissues tension.After 48 hours of CDT,affected limb circumference decreased significantly compared with the preoperative measurement [thigh (54.25 ±5.79) cm vs (56.46±5.91) cm; leg(44.05 ±5.18) cm vs (45.68 ±5.16) cm,all P＜0.05].At the time of discharge,there was no significant difference between affected limb circumference and normal side [thigh (49.00±4.67) cmvs (48.38 ±4.68) cm; leg(38.41 ±4.15) cm vs (37.73 ±3.92)cm,all P ＜ 0.05].The patency rate of iliac venous stent was 91.1％ (41/45) after 6 months.Doppler ultrasound showed regurgitation of femoral venous valve in 11 patients after 12 months.Conclusions CDT with prolonged infusion of low dose urokinase is a safe,highly effective method for the treatment of acute iliacfemoral venous thrombosis. Key words: Deep venous thrombosis, lower extremity; Iliac vein; Femoral vein; Catheter-directed thrombolysis ; Safety ; Treatment outcome