Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry.
OBJECTIVE
To evaluate catheter-directed thrombolysis for treatment of symptomatic lower extremity deep venous thrombosis (DVT).


METHODS
From a registry of patients (n = 473) with symptomatic lower limb DVT, results of 312 urokinase infusions in 303 limbs of 287 patients (137 male and 150 female patients; mean age, 47.5 years) were analyzed. DVT symptoms were acute (< or = 10 days) in 188 (66%) patients, chronic (> 10 days) in 45 (16%), and acute and chronic in 54 (19%). A history of DVT existed in 90 (31%). Lysis grades were calculated by using venographic results.


RESULTS
Iliofemoral DVT (n = 221 [71%]) and femoral-popliteal DVT (n = 79 [25%]) were treated with urokinase infusions (mean, 7.8 million i.u.) for a mean of 53.4 hours. After thrombolysis, 99 iliac and five femoral vein lesions were treated with stents. Grade III (complete) lysis was achieved in 96 (31%) infusions; grade II (50%-99% lysis), in 162 (52%); and grade I (< 50% lysis), in 54 (17%). For acute thrombosis, grade III lysis occurred in 34% of cases of acute and in 19% of cases of chronic DVT (P < .01). Major bleeding complications occurred in 54 (11%) patients, most often at the puncture site. Six patients (1%) developed pulmonary emboli. Two deaths (< 1%) were attributed to pulmonary embolism and intracranial hemorrhage. At 1 year, the primary patency rate was 60%. Lysis grade was predictive of 1-year patency rate (grade III, 79%; grade II, 58%; grade I, 32%; P < .001).


CONCLUSIONS
Catheter-directed thrombolysis is safe and effective. These data can guide patient selection for this therapeutic technique.
Mewissen
M W
MW
Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, USA.
Seabrook
G R
GR
Meissner
M H
MH
Cynamon
J
J
Labropoulos
N
N
Haughton
S H
SH
D005260:Female; D005268:Femoral Vein; D006801:Humans; D007084:Iliac Vein; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000008:administration & dosage* / Q000627:therapeutic use; D011152:Popliteal Vein; D011446:Prospective Studies; D011859:Radiography; D012042:Registries / Q000706:statistics & numerical data; D015607:Stents; D015912:Thrombolytic Therapy / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000628:therapy
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator