Editor's Choice – Factors Associated with Long-Term Outcome in 191 Patients with Ilio-Femoral DVT Treated With Catheter-Directed Thrombolysis

Abstract

In this observational study of CDT for ilio-femoral DVT it was demonstrated that symptom duration less than 2 weeks, absence of chronic post-thrombotic lesions and use of the pulse-spray technique for CDT resulted in better primary patency including normal valve function in the long term.

Update on early thrombus removal for iliofemoral deep vein thrombosis

“…Plasminogen activators to be used are either urokinase (median 110.000 units/ hour) or (r)tPA (median 0.6 mg/hour), acting equal sufficiently according thrombus resolution and bleeding rates but with a tendency of shorter treatment time with tPA (13). Today, rtPA is the only agent available in many countries and given in doses from 0.5 mg/ hour to 1.2 mg/hour, and the infusion volume varies from 20 ml to 120 ml (4,14). The infusion can be continuous or intermittent as pulse-spray via a catheter with multiple side-holes and tip occlusion.…”

“…The infusion can be continuous or intermittent as pulse-spray via a catheter with multiple side-holes and tip occlusion. The latter is advantageously combined with high infusion volume to "imitate" a kind of mechanical effect on the thrombus material, also shown from the Copenhagen experience, to be more sufficient than continuous infusion (14).…”

“…However, this principle might counteract the criteria for a satisfactory rate of thrombus removal before stopping the infusion. More than 50 % thrombus removal has been mostly accepted, whereas 90 % has been the threshold in the Copenhagen experience without maximum of rtPA and also used as threshold in the ATTRACT trial (4,14,15). In this context three important papers including 246 cases have to be mentioned stating that residual post procedural thrombus and lack of patency at 6 months is mostly predictive for worse PTS outcome (16,17,18).…”

“…The indication for stenting of persistent iliac obstruction after fulfilled lysis varies as well. Mostly used threshold for stenting is > 50 % remaining obstruction in the CaVenT trial and the ATTRACT trial and in the Copenhagen experience only 10-15 % remaining obstruction was accepted without stenting (14,15,19). Ballooning alone is insufficient because the vein will recoil.…”

“…The last paper to present is the non-randomized observational cohort study from Copenhagen (2017) with 203 limbs in 191 patients aged 14-74 years with iliofemoral DVT treated with CDT (14). Median follow-up was 5 years (range: 1 month -14.3 years].…”