Background: Catheter-directed thrombolysis (CDT) with assisted mechanical thrombolysis is the standard of medical care for proximal deep vein thrombosis (DVT). We studied the immediate and intermediate (six months) safety and effectiveness of CDT in patients with proximal lower limb DVT. Methods: Thirty consecutive patients aged between 20-70 years with proximal lower limb DVT formed the study group. CDT was done with streptokinase infuse through a catheter kept in the ipsilateral popliteal vein. Un-fractionated heparin (UFH) was given along with streptokinase. Mechanical thromboaspiration using guiding catheter was performed in addition to thrombolytic therapy. After 6 months, post-thrombotic syndrome (PTS) and deep venous patency were assessed by using Villalta scale and duplex ultrasound, respectively. Results: Thirty patients with proximal lower limb DVT were treated with CDT. Mean age of the study patients was 41.7 +/- 15 years. Mean duration of illness was 13.3 +/- 12 days. The mean duration of thrombolysis was 4.5 +/- 1.3 days. Grade III (complete) lysis was achieved in 10 (33%) and grade II (50%e90%) lysis in 20 (67%) of patients. Patients with significant residual lesion in grade II lysis following CDT underwent percutaneous transluminal angioplasty alone (12/20) or venous stenting (8/20). All patients improved clinically following CDT or assisted CDT. Four patients (13%) developed pulmonary embolism during course of hospital stay and among them 2 (6.5%) patients died. Eleven patients (37%) had minor bleeding or hematoma at local site, and 7 (23%) developed anemia requiring blood transfusion and 4 (13%) patients had thrombocytopenia. After 6 months, iliofemoral patency was found in 20 (72%) and PTS was seen in 6 (21%) patients. Two (6.5%) patients died during follow-up due to nephrotic syndrome and carcinoma breast. Conclusion: CDT and conventional manual aspiration thrombectomy is an effective treatment for proximal lower extremity DVT with good short and intermediate outcome.
Patra, S., Nagesh, C. M., Reddy, B., Srinivas, B. C., & Manjunath, C. N. (2014). Catheter directed thrombolysis in the management of proximal lower limb deep venous thrombosis – A prospective study with 6-month follow-up. Indian Heart Journal, 66, S93. https://doi.org/10.1016/j.ihj.2014.10.257