[Local thrombolysis in proximal deep venous thrombosis of the lower extremity].
BACKGROUND
Deep venous thrombosis (DVT) often leads to chronic venous insufficiency and the present study was conducted in order to investigate the effectiveness of catheter-directed thrombolysis in patients with proximal DVT of the lower extremity (iliac vein involved), with respect to recanalisation and maintenance of venous valve function.


METHODS
A prospective clinical investigation was carried out with puncture of the popliteal vein for continuous infusion of r-alteplase. Twelve patients suffering from recent proximal DVT were treated: In 10 patients the left extremity was affected, in two the right. Three of the 12 patients had factor V Leiden mutation in the heterozygote form, one of whom also had prothrombin mutation in heterozygote form.


RESULTS
Ten of the 12 had their venous thrombosis successfully lysed and were discharged with an open venous system in the affected limb. The lysed venous segments remained patent in all ten, with normal venous valve function, as evaluated by Doppler reflux testing. The median follow-up time was five months (range 0-9 months). In one patient, the proximal thrombus (iliac) was lysed successfully, but the femoral vein could not be opened, probably because of an old thrombus remaining from a previous DVT episode. In the other patient, the venous thrombus was lysed successfully, but the vein rethrombosed after one day.


CONCLUSIONS
Catheter-directed thrombolysis appears feasible in patients with recent proximal DVT and the short-term results are good in terms of venous patency and valve function. A randomised trial is necessary to test whether this treatment modality is superior to conventional anticoagulation therapy.
Sillesen
Henrik H
HH
Karkirurgisk afdeling B, Amtssygehuset i Gentofte, Niels Andersens Vej 65, DK-2900 Hellerup. sillesen@dadlnet.dk
Just
Sven R Lundgren
SR
Jørgensen
Maja
M
Bing
Mette H
MH
Baekgaard
Niels
N
Jensen
Leif Panduro
LP
D000293:Adolescent; D000328:Adult; D002408:Catheters, Indwelling; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator