Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis.
OBJECTIVE
To evaluate the efficacy of catheter-directed thrombolysis with urokinase in treating symptomatic iliofemoral deep venous thrombosis (DVT).


METHODS
Twenty-one consecutive patients with iliofemoral DVT underwent treatment for 27 affected limbs (acute DVT, n = 20; chronic DVT, n = 7). The average urokinase dose was 4.9 million IU (range, 1.4 million to 16.0 million IU) infused over an average of 30 hours (range, 15-74 hours).


RESULTS
Lysis was complete in 18 (72%), partial in five (20%), and not achieved in two (8%) of 25 treated limbs. Two chronically occluded iliac veins could not be crossed with a guide wire and did not receive urokinase. Sixteen limbs had underlying venous stenoses (> 50%) that were treated with angioplasty (n = 2) or angioplasty and stent placement (n = 14). There were no major complications or clinically detectable pulmonary emboli. The technical and clinical success rates were 85%.


CONCLUSIONS
This initial experience suggests that catheter-directed thrombolysis with urokinase for treatment of symptomatic iliofemoral DVT is safe and effective.
Semba
C P
CP
Division of Cardiovascular-Interventional Radiology, Stanford University Medical Center, CA 94305.
Dake
M D
MD
D002406:Catheterization, Peripheral; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein; D006801:Humans; D007084:Iliac Vein; D007262:Infusions, Intravenous / Q000379:methods; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use
D014568:Urokinase-Type Plasminogen Activator