Extensive acute deep vein thrombosis of the iliocaval segment: midterm results of thrombolysis and stent placement.
OBJECTIVE
To evaluate patency and clinical outcome in patients treated with catheter-directed thrombolysis and stent placement for acute extensive thrombosis affecting the iliocaval segment.


METHODS
During a 10-year period (1994-2005), 37 patients with 44 limbs (26 female, median age 31 years) with acute extensive venous thrombosis affecting the iliocaval segment were treated with catheter-directed thrombolysis. Angioplasty and stent placement was performed in 36 limbs (82%) for underlying stenosis or residual thrombosis. A prospectively registered database was analyzed in combination with a telephone interview about clinical symptoms.


RESULTS
Technical success was achieved in all 44 limbs and clinical success in 42 of 44 (96%) limbs. Primary patency after a median imaging follow-up interval of 16 months was 34 of 44 (77%) limbs, assisted primary patency was 38 of 44 (86%) limbs, and secondary patency was 39 of 44 (89%) limbs. Thirty of 44 (68%) limbs were asymptomatic after a median clinical follow-up of 27 months, eight (18%) limbs were moderately improved, two (5%) limbs were unchanged, two (5%) limbs were moderately worse, and two (5%) limbs had no clinical follow-up. Complications occurred in six (16%) patients, three (8%) of which were major complications. No patient developed symptomatic pulmonary embolism.


CONCLUSIONS
Catheter-directed thrombolysis and stent placement is a safe and effective treatment for acute iliocaval thrombosis. Clinical midterm results are encouraging. Thrombolyzed and stented segments remain patent in the vast majority of patients after 16 months. Primary and aggressive stent placement in the iliocaval vein segments can prevent rethrombosis and ensure patency.
Kölbel
Tilo
T
Department of Vascular Diseases, Malmö University Hospital, Malmö, Sweden. tilo.kolbel@skane.se
Lindh
Mats
M
Holst
Jan
J
Uher
Petr
P
Eriksson
Karl-Fredrik
KF
Sonesson
Björn
B
Malina
Martin
M
Ivancev
Krasnodar
K
D000208:Acute Disease; D000328:Adult; D000800:Angioplasty, Balloon; D000925:Anticoagulants / Q000627:therapeutic use; D019992:Databases as Topic; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007084:Iliac Vein; D007866:Leg / Q000098:blood supply; D008297:Male; D011446:Prospective Studies; D015641:Radiography, Interventional; D015607:Stents; D053828:Stockings, Compression; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014654:Vascular Patency; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000628:therapy*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin