title: Ultrasound-accelerated catheter-directed thrombolysis in acute iliofemoral deep venous thrombosis.
abstract: BACKGROUND
  Iliofemoral deep venous thrombosis (DVT) is associated with a high incidence of the post-thrombotic syndrome. The current CHEST guidelines suggest that catheter-directed thrombolysis can be used for patients with acute iliofemoral DVT and severe leg complaints. Current literature shows that catheter-directed thrombolysis increases patency of the affected tract and may reduce post-thrombotic complications, but treatment time and bleeding complications are high. Ultrasound-accelerated catheter-directed thrombolysis (UACDT) uses ultrasound waves to enhance clot lysis, which should lower treatment time and bleeding complications with the same or higher patency rates. We report our clinical experience with UACDT on patency and complications in patients with acute iliofemoral DVT.
  
  
  METHODS
  Patients treated with UACDT for acute iliofemoral DVT were included in our analyses. Diagnosis of iliofemoral DVT was confirmed using duplex sonography and magnetic resonance venography. In addition to thrombolysis, stents were placed or an arteriovenous fistula was created to ensure patency of the treated vein, if indicated. The main outcome is patency after 1 year. Secondary outcome measures are treatment time, bleeding complications, and pulmonary embolism. Patency was assessed using duplex sonography.
  
  
  RESULTS
  In total, 37 patients (average age at intervention, 42 years; range, 5-76 years) were included. The DVT location was unilateral in 33 patients (20 left side, 13 right side), and four were bilateral. The average treatment time was 43 ±17 hours. The success rate of thrombolysis was 95% (n = 35); re-thrombosis occurred in 11 (30%) patients. Major bleeding occurred in one patient (3%), and three minor bleedings occurred at the insertion side of the catheter (8%). One pulmonary embolism was encountered (3%). One patient had fever with positive blood cultures for Staphylococcus aureus. Additional procedures were required in 54% (n = 20) of patients. Primary patency was 70% at 1 year; secondary patency was 87% after 1-year follow up.
  
  
  CONCLUSIONS
  UACDT of acute iliofemoral DVT is feasible and safe. Supplementary percutaneous transluminal angioplasty and stenting play an important role in preventing re-thrombosis.
authors.affiliation: Department of Vascular Surgery and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: rob.strijkers@mumc.nl.
authors.forename: Rob H W
authors.initials: RH
authors.lastname: Strijkers
authors.affiliation: Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Grommes
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Carsten W K P
authors.initials: CW
authors.lastname: Arnoldussen
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Rick
authors.initials: R
authors.lastname: de Graaf
authors.affiliation: Laboratory for Clinical Thrombosis and Haemostasis and Laboratory of Haematology, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
authors.forename: Arina J
authors.initials: AJ
authors.lastname: Ten Cate
authors.affiliation: Department of Vascular Surgery and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Cees H A
authors.initials: CH
authors.lastname: Wittens