Catheter directed thrombolysis for treatment of llio-femoral deep venous thrombosis is durable, preserves venous valve function and may prevent chronic venous insufficiency

Objectives. To investigate the results of catheter directed thrombolysis offered to patients with acute femoro-iliac deep venous thrombosis (DVT). Design. Retrospective analysis of all patients treated with this modality at Gentofte Hospital until December 2003. Material. Forty-five consecutive patients treated between June 1999 and December 2003 with a median age of 31 years. All patients had femoro-iliac DVT with an average anamnesis of 6 days. Methods. All patients were treated by catheter directed infusion of alteplase into the popliteal vein. After thrombolysis residual venous stenoses were treated by percutaneous balloon angioplasty (PTA) and stenting. Patients were followed with color-duplex scanning for assessment of venous patency and reflux. Results. Forty-two of 45 (93%) of cases were treated successfully with reopening of the thrombosed vein segments. In 30 of 45 cases a residual stenosis was treated by PTA and stenting. Only one serious complication was observed: Compartment syndrome of the forearm where arterial punctures had been taken. After an average of 24 months follow-up were no cases of re-thrombosis among the 42 patients discharged with open veins. Only two of 41 with presumed normal venous valve function prior to DVT developed reflux during follow-up. Conclusion. In this selected patient group, catheter directed thrombolysis seems effective in treating acute DVT, it appears durable and preserves venous valve function in the majority. The method needs to be tested in a randomised controlled trial.