A strategy of aggressive regional therapy for acute iliofemoral venous thrombosis with contemporary venous thrombectomy or catheter-directed thrombolysis

Iliofemoral Deep Vein Thrombosis: Conventional Therapy Versus Lysis and Percutaneous Transluminal Angioplasty and Stenting

“…The experience of others with systemic thrombolysis for iliofemoral venous thrombosis has been somewhat disappointing. 15,24 Because of the presence of venous collaterals that develop in venous occlusion, it is not usually possible to deliver the lytic agent directly to the thrombus when systemic infusion is used. Transcatheter infusion of a lytic agent can deliver high concentrations directly into the thrombus while minimizing the potential for a systemic fibrinolytic effect.…”

“…[11][12][13][14] Transcatheter regional lytic therapy allows a higher concentration of the lytic agency to be introduced directly into the clot, resulting in a more rapid dissolution of the thrombus and reduced hemorrhagic complications compared than with systemic lysis. 15,16 This study compares catheter-directed thrombolysis combined with angioplasty and stenting with conventional anticoagulation in treating patients with iliofemoral DVT.…”

“…Other studies likewise failed to show symptomatic pulmonary embolism. 15 In our practice, we do not routinely insert caval filters before lytic therapy unless there is an indication for one. In our study of 18 patients who underwent thrombolysis, there were no episodes of pulmonary embolism.…”

“…Transcatheter infusion of a lytic agent can deliver high concentrations directly into the thrombus while minimizing the potential for a systemic fibrinolytic effect. 15,25 A theoretical consideration with catheter-directed lytic therapy is dislodgement of significant thrombotic material, which may lead to a pulmonary embolism. In 1994, Semba and Dake 14 reported one of the first series of patients treated for venous thrombosis with catheter-directed thrombolysis.…”

Phlegmasia cerulea dolens

“…7,8 In addition to leg elevation, medical anticoagulation with heparin or thrombectomy may be employed, depending on the clinical scenario. 9 According to a recent study by Tardy et al, 10 intravenous thrombolysis can be considered a treatment modality for PCD. Although no significant improvement in Marder score was noted after thrombolysis, there was no progression to venous gangrene, major hemorrhage, or death, and no amputation was needed.…”