Hannu Ilmari Manninen MD, Presenter: Nothing to Disclose

Auni Juutilainen MD, Abstract Co-Author: Nothing to Disclose

Erkki Kaukanen MD, Abstract Co-Author: Nothing to Disclose

Seppo Lehto MD, PhD, Abstract Co-Author: Nothing to Disclose

To evaluate in a prospective study the primary and long term results of selective catheter-directed thrombolysis and systemic thrombolysis in treating proximal deep vein thrombosis (DVT) of lower extremity.

During an 8-year period 56 patients with mean age of 48 (range 15-81) years with acute DVT, extending to high femoral (16 patients) or iliac vein (40 patients) were treated with selective catheter-directed thrombolysis and adjunctive balloon angioplasty.. Endovascular stenting was performed in 9 of the iliac DVT patients.The mean total dose of 3.8 (range 1.0 - 8.1) million units of urokinase was administered during a mean of 39 (range 6-72) hours. A group of ten patients (mean age 65 years, range 44-78 years)) with DVT extending to high femoral vein were treated with systemic thrombolysis using streptokinase.

Complete procedural venographic success was registered in 79% (44/56) of patients in the catheter-directed thrombolysis group but in none of the patients in the systemic thrombolysis group. The rates of major complications were 7% (4/56) in the selective and 10% (1/10) in the systemic thrombolysis group patients. Follow-up extending to a mean of 3.5 years (range 3 months to 9.6 years) demonstrated well preserved femoral vein valves and fully recanalized deep crural veins in 83% and 57% of the selective and in 30% and 0% of the systemic thrombolysis group patients in venography, correspondingly. Clinical posthrombotic syndrome was registered in 9% of catheter-directed  therapy and 33% of systemic thrombolysis patients ( P=0.08).

Our results suggest limited value of systemic thrombolysis in the therapy of acute DVT. While it may recanalize thrombotic segment in selected cases, it is associated with bleeding complications and limited efficacy of PTS prevention. Selective catheter-directed therapy of  acute proximal DVT gives good primary success with acceptable rate of complications and prevents effectively postthrombotic syndrome. Although a randomized trial between catheter-directed therapy and anticoagulation alone is requested, our data supports offering catheter-directed therapy on acute proximal DVT.

Although a randomized trial between catheter-directed therapy and anticoagulation alone is requested, our data supports offering catheter-directed therapy on acute proximal DVT.  

Manninen, H, Juutilainen, A, Kaukanen, E, Lehto, S, Catheter-directed Therapy and Systemic Thrombolysis of Proximal Lower Extremity Deep Vein Thrombosis: A Prospective Trial with Venographic and Clinical Follow-up Reaching Ten Years.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8014556.html