Background
Catheter-directed thrombolysis (CDT) for the treatment of acute iliofemoral deep venous thrombosis (IFDVT) has the advantages of prompt thrombus removal, restoration of the vein patency, and maintenance of the valve function. It also facilitates endovascular treatment of the commonly-encountered vein lesions. Therefore, the aim of the study is to assess the efficacy, safety, short-term patency rates, and incidence of post-thrombotic syndrome (PTS) following CDT treatment of IFDVT.
Patients and methods
This is a prospective study of all adult patients who underwent CDT for the treatment of acute, nonrecurrent, radiologically proven IFDVT at the Department of Vascular and Endovascular Surgery, Assiut University Hospital (a tertiary referral hospital), between June 2015 and November 2016.
Results
Sixty-four patients (64 limbs) underwent CDT for treatment of acute IFDVT. The overall success rate was 93.8%. Balloon angioplasty was performed in 58 (96.7%) patients, of which, 54 (90%) required stent placement. Eight (12.5%) bleeding complications were encountered in the study, with only one major bleeding event. No periprocedural cerebral hemorrhage, pulmonary embolism, or deaths occurred. At 1 year, the cumulative primary patency rate was 76.5%. Seven (12.1%) patients had symptoms of PTS (four mild, two moderate, and one severe) without occurrence of venous ulceration in any patient.
Conclusion
CDT is a safe and effective treatment option for patients with acute IFDVT, with satisfactory technical success and acceptable short-term primary patency rates. Prompt thrombus lysis associated with adjunctive treatment of vein lesions can help reduce rate of rethrombosis and the subsequent development of PTS.