[Catheter-directed thrombolysis of iliofemoral venous thrombosis].
BACKGROUND
Although a success rate of 80% has been reported in patients with iliofemoral venous thrombosis treated with catheter-based thrombolysis, the possible long-term benefit of this treatment is not known.


METHODS
28 consecutive patients referred for catheter-based thrombolysis of iliofemoral venous thrombosis were treated with infusion of alteplase into the thrombus for two to five days. Following thrombolysis, warfarin was given for at least one year. All patients were examined every six months with colour duplex scanning and air pletysmography.


RESULTS
100% thrombolysis was achieved in eight patients, 75-99% in ten, 50-74% in nine and < 50% in one patient. Angioplasty (four) or stent implantation (four) was successful in eight out of twelve patients with stenosis of the left common iliac vein. Early recurrence of thrombosis (< 7 days) occurred in three patients, pulmonary embolism in one, and bleeding at the insertion site in six. After a mean follow-up of 2.5 years, 17 patients were free of symptoms, seven had a mild degree and four a moderate degree of postthrombotic syndrome. Eighteen patients had normal venous physiology, nine deep venous reflux, and three functional obstruction of deep veins. Postthrombotic syndrome was associated with deep venous reflux and/or functional obstruction of the iliofemoral segment.


CONCLUSIONS
Catheter-based thrombolysis is a safe and effective treatment of proximal deep venous thrombosis and might reduce the occurrence of postthrombotic syndrome compared to treatment with anticoagulation alone.
Ly
Bernt
B
Hematologisk avdeling, Aker universitetssykehus, Oslo. bernterik.ly@akersykehus.no
Njaastad
Anne Mette
AM
Sandbaek
Gunnar
G
Solstrand
Randi
R
Rosales
Antonio
A
Slagsvold
Carl-Erik
CE
D000293:Adolescent; D000328:Adult; D005260:Female; D005268:Femoral Vein; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007084:Iliac Vein; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D020246:Venous Thrombosis / Q000188:drug therapy*; D014859:Warfarin / Q000008:administration & dosage
D005343:Fibrinolytic Agents; D014859:Warfarin; D010959:Tissue Plasminogen Activator