Catheter-Directed Thrombolysis and Endovascular Therapy in Deep Vein Thrombosis Patients: Early and First Year Results

Deep Vein Thrombosis leads to post thrombotic syndrome in the long term. The risk of developing a post thrombotic syndrome increases when anticoagulation is the only treatment. Catheter-directed thrombolysis methods were developed because of the high bleeding risk of systemic thrombolytic therapy. Along with hybrid approaches Catheter-directed thrombolysis aim to reduce the frequency of post thrombotic syndrome. We retrospectively report the early and follow-up results of our patients in whom we performed Catheter-directed thrombolysis. METHODS: 31 patients(aged 23-87) had been diagnosed with acute proximal Deep Vein Thrombosis(≤15 days’ duration). Catheter-directed thrombolysis and if needed stent implantations were performed successfully. The patients who had a thrombosis of the inferior vena cava also underwent the placement of a vena cava filter. Patients were evaluated at 1, 6 and 12 months. Villalta scores were also determined for the diagnosis of post thrombotic syndrome. RESULTS: 19 had a thrombus in the iliofemoral. The thrombus was extending to the inferior vena cava in six patients. In 12 patients the thrombus was femoropopliteal. The six patients whose thrombus extended to the inferior vena cava, underwent venous filter placement. In five of the iliofemoral-thrombus patients, intraoperative control venography revealed iliac stenosis. This stenosis was treated with iliac stent implantation. Clot-lysis was completely(>90% lysis) in twelve, partially(50-90% lysis) in seven of the 19 iliofemoral-thrombus patients. Ten of the femoropopliteal-thrombus patients achieved a complete and two a partial clot-lysis. There was minor bleeding in two patients. Major bleeding was not reported. DISCUSSION AND CONCLUSION: Catheter-directed thrombolysis reduce the frequency of post thrombotic syndrome. Residual venous obstruction after Catheter-directed thrombolysis should be treated by balloon dilatation/stent implantation to prevent re-thrombosis. We believe that treatment with a hybrid approach may be more effective in protecting patients from post thrombotic syndrome.