Iliofemoral deep vein thrombosis: conventional therapy versus lysis and percutaneous transluminal angioplasty and stenting.
OBJECTIVE
To compare conventional treatment (heparin and warfarin) of iliofemoral venous thrombosis with multimodality treatment (lysis and stenting).


BACKGROUND
Several studies have reported on conventional therapy for iliofemoral venous thrombosis with disappointing results. However, more recent studies have reported better results with multimodality treatment.


METHODS
Fifty-one consecutive patients with extensive iliofemoral venous thrombosis were treated during a 10-year period. If there were no contraindications, patients were given the option to choose between conventional therapy (group 1) and multimodality therapy (group 2). The multimodality treatment strategy included catheter-directed lysis followed by percutaneous transluminal balloon angioplasty (PTA) and stenting for residual iliac stenoses. All patients underwent routine venous duplex imaging at 30 days, 3 months, 6 months, and every 6 months thereafter.


RESULTS
There were 33 patients in group 1 and 18 patients in group 2. Demographic and clinical characteristics were comparable for both groups. Initial lysis was achieved in 16 of 18 patients (89%) in group 2. Ten of 18 patients in group 2 had residual stenosis after lysis (8 primary and 2 secondary to malignancy), and they were treated with PTA/stenting with an initial success rate of 90%. Two patients in group 1 (6%) had a symptomatic pulmonary embolism (none in group 2). At 30 days, venous patency and symptom resolution were achieved in 1 of 33 patients (3%) in group 1 versus 15 of 18 (83%) in group 2. Kaplan-Meier analysis showed primary iliofemoral venous patency rates at 1, 3, and 5 years of 24%, 18%, and 18% and 83%, 69%, and 69% for groups 1 and 2, respectively. Long-term symptom resolution was achieved in 10 of 33 patients (30%) in group 1 versus 14 of 18 (78%) in group 2. Kaplan-Meier life table analysis showed similar survival rates at 1, 3, and 5 years of 100%, 93%, and 85% for group 1 and 100%, 93%, and 81% for group 2.


CONCLUSIONS
Lysis/stenting treatment was more effective than conventional treatment in patients with iliofemoral vein thrombosis.
AbuRahma
A F
AF
Department of Surgery, Charleston Area Medical Center, Robert C. Byrd Health Sciences Center of West Virginia University, Charleston, West Virginia 25304, USA. Ali.aburahma@camcare.com
Perkins
S E
SE
Wulu
J T
JT
Ng
H K
HK
D000800:Angioplasty, Balloon; D000925:Anticoagulants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005268:Femoral Vein; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007084:Iliac Vein; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000188:drug therapy / Q000628:therapy*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin; D006493:Heparin