title: Endovascular management of proximal lower limb deep venous thrombosis - A prospective study with six-month follow-up.
abstract: BACKGROUND
  Catheter-directed thrombolysis with assisted mechanical thrombolysis is the standard of medical care for proximal deep vein thrombosis. We studied the immediate and intermediate (six months) safety and effectiveness of catheter-directed thrombolysis in patients with proximal lower limb deep vein thrombosis.
  
  
  METHODS
  Thirty consecutive patients aged between 20 and 70 years with proximal lower limb deep vein thrombosis formed the study group. Catheter-directed thrombolysis was done with streptokinase infuse through a catheter kept in the ipsilateral popliteal vein. Unfractionated heparin was given along with streptokinase. Mechanical thromboaspiration using guiding catheter was performed in addition to thrombolytic therapy. After six months, post-thrombotic syndrome and deep venous patency were assessed by using Villalta scale and duplex ultrasound, respectively.
  
  
  RESULTS
  Thirty patients with proximal lower limb deep vein thrombosis were treated with catheter-directed thrombolysis. Mean age of the study patients was 41.7 ± 15 years. Mean duration of illness was 13.3 ± 12 days. The mean duration of thrombolysis was 4.5 ± 1.3 days. Grade III (complete) lysis was achieved in 10 (33%) and Grade II (50-90%) lysis in 20 (67%) of patients. Patients with significant residual lesion in Grade II lysis following catheter-directed thrombolysis underwent percutaneous transluminal angioplasty alone (12/20) or venous stenting (8/20). All patients improved clinically following catheter-directed thrombolysis or assisted catheter-directed thrombolysis. Four patients (13%) developed pulmonary embolism during course of hospital stay and among them two (6.5%) patients died. Eleven patients (37%) had minor bleeding or hematoma at local site, and seven (23%) developed anemia requiring blood transfusion and four (13%) patients had thrombocytopenia. After six months, iliofemoral patency was found in 20 (72%) and post-thrombotic syndrome was seen in six (21%) patients. Two (6.5%) patients died during follow-up due to nephrotic syndrome and carcinoma breast.
  
  
  CONCLUSIONS
  Catheter-directed thrombolysis and conventional manual aspiration thrombectomy are an effective treatment for proximal lower extremity deep vein thrombosis with good short and intermediate outcome.
authors.affiliation: Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India dr_soumyapatra@rediffmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Patra
authors.affiliation: Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
authors.forename: B C
authors.initials: BC
authors.lastname: Srinivas
authors.affiliation: Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
authors.forename: C M
authors.initials: CM
authors.lastname: Nagesh
authors.affiliation: Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
authors.forename: B
authors.initials: B
authors.lastname: Reddy
authors.affiliation: Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
authors.forename: C N
authors.initials: CN
authors.lastname: Manjunath
mesh_terms: D000328:Adult; D000368:Aged; D017130:Angioplasty; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D061185:Mechanical Thrombolysis; D008875:Middle Aged; D011446:Prospective Studies; D020246:Venous Thrombosis / Q000628:therapy*
keywords: Catheter-directed thrombolysis; deep vein thrombosis; iliofemoral; post-thrombotic syndrome; streptokinase