Role of Catheter-directed Thrombolysis in Management of Iliofemoral Deep Venous Thrombosis

Abstract

The treatment for iliofemoral deep venous thrombosis (DVT) is challenging, as the use of anticoagulation alone can be insufficient for restoring venous patency and thus lead to prolongation of acute symptoms and an increased risk of chronic complications, including venous insufficiency and postthrombotic syndrome (PTS). In these cases, earlier and more complete thrombus removal can ameliorate acute symptoms and reduce long-term sequelae. Endovascular therapies involving the use of pharmacologic, mechanical, and combined pharmacomechanical modalities have been developed to achieve these goals. The most frequently used of these techniques, catheter-directed thrombolysis (CDT), involves the infusion of a thrombolytic agent through a multiple-side-hole catheter placed within the thrombosed vein to achieve high local doses and thereby break down the clot while minimizing systemic thrombolytic agent exposure. Randomized controlled trial results have indicated decreased PTS rates and improved venous patency rates in patients treated with CDT compared with these rates in patients treated with anticoagulation. The use of newer pharmacomechanical techniques, as compared with conventional CDT, reduces procedural times and thrombolytic agent doses and is the subject of ongoing investigations. Endovascular thrombus removal techniques offer a means to improve venous valvular function and decrease the risk of debilitating long-term complications such as PTS and are a promising option for treating patients with iliofemoral DVT. (©)RSNA, 2016.

Pathogenesis of Thromboembolism and Endovascular Management

“…However, patient numbers are low (18) and follow-up is only short term at 6 months after procedure [70]. In 2014, Cakir et al presented findings supporting the use of percutaneous aspiration thrombectomy over AC monotherapy in a randomized clinical trial involving 42 patients [71].…”

Protocolo interhospitalario de actuación en las salas de radiología intervencionista durante la COVID-19

“…Las técnicas por radiología intervencionista actualmente se encuentran en la primera línea de batalla para afrontar muchas condiciones de emergencia que ponen en peligro la vida del paciente, y no deben ser la excepción los pacientes con este tipo de infección 20 (Tabla 4) [21][22][23][24][25][26][27][28][29][30] .…”

Post-thrombotic syndrome prevention – do we really know the predictive factors?

“…Historically, the possibility of the rapid vein lumen restoration in DVT patients was proven in the patients that underwent venous surgical thrombectomy. Currently invasive acute proximal DVT treatment, in most of the cases, is performed as local catheter directed thrombolysis or pharmaco-mechanical methods (46)(47)(48)(49)(50)(51). Despite the technical progress in the procedure performance as well as encouraging reports concerning the prospective observation of the case series, the efficacy of this treatment modality in term of PTS prevention remains questionable.…”