title: Catheter-directed thrombolysis and pharmacomechanical thrombectomy improve midterm outcome in acute iliofemoral deep vein thrombosis.
abstract: BACKGROUND
  Aggressive and early thrombus removal strategy has been widely used as a treatment for iliofemoral deep vein thrombosis (DVT). We compared the long-tem venous outcome, including postthrombotic syndrome (PTS), in patients undergoing catheter-directed thrombolysis (CDT) and pharmacomechanical thrombectomy (PMT).
  
  
  METHODS
  From January 2009 to December 2013, 61 patients with acute proximal DVT were enrolled in this prospective study. Thirty-one patients underwent CDT and 30 patients underwent PMT, and each patient was followed for at least 2 years after treatment. Observations included venous outflow resistance, venous insufficiency, thrombus score (TS), severity of PTS, and surgical complications.
  
  
  RESULTS
  Venous outflow obstruction was similar in the CDT and PMT groups (32.3% vs. 30.0%, p = 0.695), and venous insufficiency of each group was 38.7% and 30.0% (p = 0.774), respectively. The TS at 24 months of each group showed no significant difference (0.90 vs. 0.70, p = 0.526). The mean Villalta scale scores of the CDT and PMT groups were 3.13 and 1.87, respectively (p = 0.042). Patients without PTS had significantly lower TS since 1 week postoperatively (1.59 vs. 4.60, p < 0.001). The severity of PTS was highly correlated with the TS, rate of thrombolysis, and severity of obstruction, and was moderately correlated with the venous registry index and reflux severity.
  
  
  CONCLUSIONS
  CDT and PMT have similar venous outcomes in patients with acute iliofemoral DVT, although PTS is less severe following PMT than after CDT. We propose that early and thorough removal of thrombus, using either CDT or PMT, is beneficial to prevent PTS.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Tzu-Ting
authors.initials: TT
authors.lastname: Kuo
authors.affiliation: Division of Cardiovascular Surgery, Far East Memorial Hospital, New Taipei City, Taiwan, ROC.
authors.forename: Chun-Yang
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University Taipei, Taiwan, ROC.
authors.forename: Chiao-Po
authors.initials: CP
authors.lastname: Hsu
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; National Defense Medical Center, Taipei, Taiwan, ROC. Electronic address: tumorlee0701@hotmail.com.
authors.forename: Chiu-Yang
authors.initials: CY
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral; D005260:Female; D005268:Femoral Vein / Q000601:surgery*; D006801:Humans; D007084:Iliac Vein / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017131:Thrombectomy; D015912:Thrombolytic Therapy / Q000379:methods*; D020246:Venous Thrombosis / Q000628:therapy*
keywords: catheter-directed thrombolysis; deep vein thrombosis; pharmacomechanical thrombectomy; postthrombotic syndrome