Purpose
The aim was to assess the role of catheter-directed thrombolysis (CDT) in
improving patency of the treated venous segments and to examine the
correlation of residual thrombus with post-thrombotic syndrome (PTS).
Background
Iliofemoral deep vein thrombosis (DVT) is associated with severe post-thrombotic
morbidity when treated with anticoagulation alone. CDT allows early removal of
thrombus and reduce valvular reflux and PTS.
Patients and methods
This prospective randomized controlled two-arm study was conducted on 42
patients with iliofemoral DVT. The patients were randomly allocated into two
groups according to the intervention performed. Group A: CDT followed by oral
anticoagulants [N=21 (50%)], group B: standard DVT therapy [N=21 (50%)]. The
follow-up period was 24 months.
Results
Patients of group A complained of less pain at 10 and 30 days (P=0.02 and 0.04,
respectively). Also, there was significant decrease in leg circumference in group A at
10 and 30 days (P=0.001 and 0.03, respectively). A total of three (15%) clinically
relevant nonmajor bleeding complications were reported in the CDT group. Using
CDTisassociatedwith lessPTSat sixthmonth,1year,and2years; six (27.3%),seven
(31.8%), and nine (40.9%), respectively, as compared with group B; 11 (47.8%), 13
(56.5%), and 15 (65.2%), respectively (P=0.024, 0.017, and 0.035, respectively).
Conclusion
Addition of CDT in the treatment of acute iliofemoral DVT was safe and tolerated by
most of the patients with better effect to reduce leg pain and circumference. It was
considered a protecting weapon to prevent PTS and thereby improving the quality
of life and was related to achievement of higher iliac vein patency and less reflux.