CATHETER-DIRECTED LYSIS OF ILIOFEMORAL VEIN-THROMBOSIS WITH USE OF RT-PA

The aim of our study was to evaluate the results of catheter-directed thrombolysis and complementary procedures to treat acute iliofemoral d eep vein thrombosis (DVT). A total of 24 consecutive patients with acu te iliofemoral DVT underwent intra-thrombus drip infusion of alteplase (3 mg/h; mean dosage 86 mg, range 45-174 mg), while intravenous hepar in (1000 U/h) was continued. Complementary procedures were hydrodynami c thrombectomy in 3 and primary insertion of a Wallstent in 9 patients . Patency of 19 thrombosed veins (79%) was restored with prompt sympto matic relief. An underlying anatomical anomaly or lesion was present i n 13 patients: iliac vein compression syndrome (n = 8), absent (n = 2) or obstructed (n = 1) vena cava or venous stenosis (n = 2). Ten of th e abnormalities were unknown before lysis and eight were relieved by s tent deployment. Puncture site bleeding was the only complication but led to transfusion in 6 patients (25%). Symptomatic reocclusion occurr ed in 4 patients. Catheter thrombolysis of iliofemoral vein thrombosis revealed many anatomical abnormalities which may predispose to thromb osis and are often amenable to stenting.