Thrombolysis for lower extremity deep venous thrombosis.
Catheter-directed thrombolysis (CDT) has been proposed as an alternative mode of therapy to anticoagulation in patients with massive, symptomatic deep vein thrombosis of the extremity. The major goal of therapy is to rapidly restore venous blood flow, reduce the pain and edema of the extremity, preserve venous valve function, and reduce chronic symptoms related to chronic venous hypertension (postthrombotic syndrome). In patients with iliofemoral deep venous thrombosis (DVT) standard angiographic techniques are used to instrument a lower extremity vein (popliteal) and venography is performed followed by catheter-directed infusion of a plasminogen activator directly into the thrombus. Following lytic infusion, the interventionalist must evaluate the venous drainage to determine if there is an anatomic lesion that requires further endovascular treatment (eg, iliac vein compression syndrome). Posttreatment therapy usually consists of warfarin therapy and venous compression stockings for at least 3 to 6 months. The purpose of this article is to review the technical approach used in treating iliofemoral DVT and highlight the hurdles that face interventionalists in attempting to broaden this procedure to most types of lower extremity DVT.
Semba
Charles P
CP
Division of Vascular Medicine, Genentech, Inc., 1 DNA Way, MS: 59, South San Francisco, CA 94080-4990, USA.
Razavi
Mahmood K
MK
Kee
Stephen T
ST
Sze
Daniel Y
DY
Dake
Michael D
MD
D002406:Catheterization, Peripheral / Q000191:economics / Q000379:methods / Q000592:standards; D005268:Femoral Vein / Q000473:pathology / Q000601:surgery; D005343:Fibrinolytic Agents / Q000191:economics / Q000592:standards / Q000627:therapeutic use*; D006493:Heparin / Q000191:economics / Q000592:standards / Q000627:therapeutic use*; D006801:Humans; D007084:Iliac Vein / Q000473:pathology / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply / Q000473:pathology*; D015912:Thrombolytic Therapy / Q000191:economics / Q000379:methods* / Q000592:standards; D014656:Vascular Surgical Procedures / Q000191:economics / Q000379:methods / Q000592:standards; D020246:Venous Thrombosis / Q000628:therapy*
D005343:Fibrinolytic Agents; D006493:Heparin