title: Editor's Choice - Factors Associated with Long-Term Outcome in 191 Patients with Ilio-Femoral DVT Treated With Catheter-Directed Thrombolysis.
abstract: OBJECTIVE
  To identify factors associated with long-term treatment success after catheter-directed thrombolysis (CDT) for acute deep venous thrombosis (DVT) involving the ilio-femoral vein.
  
  
  METHODS
  This was a non-randomised observational cohort study. From 1999 to 2013, 191 consecutive patients (203 limbs) attending a tertiary vascular centre at Gentofte University Hospital, Denmark underwent CDT. All patients had ultrasonically verified acute ilio-femoral DVT with open distal popliteal vein and calf veins. Patients were seen in the outpatient clinic 6 weeks, 3, 6, and 12 months, and annually thereafter following the DVT. Successful outcome was defined as patent deep veins without reflux on Duplex ultrasound scanning (DUS). Data were collected prospectively as per protocol and analysed retrospectively.
  
  
  RESULTS
  Median age was 27 years (range 14-74 years) and overall median lysis time was 56 h (range 22-146 h). A stent was placed in 106 limbs (52%). Six patients had major bleeding. The median follow-up was 5 years (range 1 month-14.3 years). The cumulative rate of patients with deep patent veins without reflux at 7 years was 79%. Multivariate Cox regression analyses showed that symptom duration >2 weeks (hazard ratio (HR) 2.78, 95% CI 1.14-6.73) and chronic post-thrombotic lesions (HR 19.3, 95% CI 7.29-51.2) were significantly associated with poorer outcome, while the pulse-spray technique (HR 0.15, 95% CI 0.05-0.48) was associated with better outcome. Age, gender, side, IVC atresia, stenting, and lysis duration did not affect outcome.
  
  
  CONCLUSIONS
  In this observational study of CDT for ilio-femoral DVT it was demonstrated that symptom duration less than 2 weeks, absence of chronic post-thrombotic lesions and use of the pulse-spray technique for CDT resulted in better primary patency including normal valve function in the long term.
authors.affiliation: Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark. Electronic address: piaf@dadlnet.dk.
authors.forename: P
authors.initials: P
authors.lastname: Foegh
authors.affiliation: Finsen Centre, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: L P
authors.initials: LP
authors.lastname: Jensen
authors.affiliation: Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Klitfod
authors.affiliation: Dept. of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Denmark; Dept. of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University of Copenhagen, Denmark.
authors.forename: R
authors.initials: R
authors.lastname: Broholm
authors.affiliation: Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: N
authors.initials: N
authors.lastname: Bækgaard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003718:Denmark; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006785:Hospitals, University; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D062666:Vascular Access Devices; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents
keywords: Catheter-directed thrombolysis (CDT); Deep venous thrombosis (DVT); Duplex ultrasound scanning (DUS); Ilio-femoral DVT; Prognostic factors; Pulse-spray