ILIOFEMORAL DEEP VENOUS THROMBOSIS - SAFETY AND EFFICACY OUTCOME DURING 5 YEARS OF CATHETER-DIRECTED THROMBOLYTIC THERAPY

PURPOSE: To prospectively evaluate the angiographic and clinical resul ts of using catheter-directed thrombolytic therapy for the treatment o f acute iliofemoral deep venous thrombosis (IFDVT). MATERIALS AND METH ODS: All consecutive patients with acute IFDVT referred for thrombolyt ic treatment from July 1990 to December 1995 were included ill this cl inical data analysis. Infusions of urokinase were administered via a m ultisidehole infusion catheter. Angioplasty, stent placement, mechanic al thrombectomy, and other procedures were often performed in conjunct ion with the thrombolytic procedure. RESULTS: Seventy-seven patients a nd 87 limbs were treated, The overall technical success rate was 79%, and was 86% for iliac veins and 63% for femoral veins. The primary and secondary patency rates at 1 year were 63% and 78%, respectively, for the iliac veins, and 40% and 51%, respectively, for the femoral veins . Patients with malignant disease fared worse. Patients requiring sten t placement appeared to have inferior outcomes. A previous history of DVT did not appear to affect the results. Bleeding requiring transfusi on and hematomas were the major complications encountered. Pulmonary e mbolus was not a significant problem. Technical success rates were low er in patients who had had symptoms for more than 4 weeks compared to those who had a more recent onset of symptoms. CONCLUSION: Current dat a suggest that catheter-directed thrombolytic therapy is safe and effe ctive in achieving intermediate-term venous patency. The long-term cli nical benefits of this procedure remain, however, to be established.