TRANSCATHETER REGIONAL UROKINASE THERAPY IN THE MANAGEMENT OF INFERIOR VENA-CAVA THROMBOSIS

PURPOSE: To study the efficacy of local infusion of urokinase (UK) in the treatment of symptomatic inferior vena cava (IVC) thrombosis. MATE RIALS AND METHODS: Eight patients (five men and three women) who range d in age from 19 years to 75 years (mean, 56 years) with symptomatic I VC thrombosis underwent local catheter-directed infusion of Uh with us e of up to three access sites. Infrarenal IVC thrombus and iliac vein thrombus was identified in all patients. Four patients had extension o f thrombus proximal to the renal veins. Seven of eight patients had at least one risk factor for NC thrombosis: hypercoagulable state (n = 3 ), IVC filter (n = 3), malignancy (n = 2), recent surgery (n = 2), and oral contraceptive use (n = 1), No serious procedure-related complica tions were encountered, although one patient died 5 days after UK ther apy of pulmonary failure due to advanced lung cancer. UK was infused f or an average of 79 hours (range, 24-140 hours) and a mean total dose of 7.4 million U of UK (range, 2.9-14.4 million U), Adjunctive balloon angioplasty was performed in three patients. No vascular stents were placed. Clinical and/or radiographic follow-up was obtained in all eig ht patients. RESULTS: Thrombolysis was successful in seven of eight (8 8%) IVCs with no or minimal residual thrombus, The remaining seven pat ients had no lower extremity swelling 2-24 months (mean, 11 months) af ter the procedure. Three of seven patients had computed tomographic or venographic follow-up (mean, 9 months; range, 1.5-15 months), demonst rating unchanged or improved IVC patency, CONCLUSIONS: Transcatheter r egional infusion of Uh for re-establishing venous patency in acute IVC thrombosis appears to be effective with good short-term and mid-term clinical benefit.