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[Local thrombolysis in proximal deep venous thrombosis of the lower extremity]
Henrik H Sillesen1, Sven R Lundgren Just, Maja Jørgensen
1Karkirurgisk afdeling B, Amtssygehuset i Gentofte, Niels Andersens Vej 65, DK-2900 Hellerup. sillesen@dadlnet.dk
Insights
Catheter-directed thrombolysis effectively restores venous patency and valve function in patients with proximal deep venous thrombosis (DVT). This minimally invasive treatment shows promising short-term outcomes for DVT management.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Hematology
Background:
- Deep venous thrombosis (DVT) can lead to chronic venous insufficiency.
- Investigating effective treatments for proximal DVT involving the iliac vein is crucial.
- Maintaining venous valve function post-treatment is a key concern.
Purpose of the Study:
- To evaluate the effectiveness of catheter-directed thrombolysis for proximal lower extremity DVT.
- To assess venous recanalisation rates after thrombolysis.
- To determine the impact on venous valve function.
Main Methods:
- Prospective clinical study involving 12 patients with recent proximal DVT.
- Popliteal vein puncture for continuous infusion of recombinant alteplase (r-alteplase).
- Evaluation of venous patency and valve function using Doppler reflux testing.
Main Results:
- Successful lysis of venous thrombosis achieved in 10 out of 12 patients.
- Maintained venous patency and normal valve function in successfully lysed limbs.
- Short-term follow-up (median 5 months) showed sustained patency in most cases.
Conclusions:
- Catheter-directed thrombolysis is a feasible treatment for recent proximal DVT.
- Short-term results demonstrate good venous patency and valve function.
- Randomized trials are needed to compare with conventional anticoagulation.
Introduction:
Deep venous thrombosis (DVT) often leads to chronic venous insufficiency and the present study was conducted in order to investigate the effectiveness of catheter-directed thrombolysis in patients with proximal DVT of the lower extremity (iliac vein involved), with respect to recanalisation and maintenance of venous valve function.
Material And Methods:
A prospective clinical investigation was carried out with puncture of the popliteal vein for continuous infusion of r-alteplase. Twelve patients suffering from recent proximal DVT were treated: In 10 patients the left extremity was affected, in two the right. Three of the 12 patients had factor V Leiden mutation in the heterozygote form, one of whom also had prothrombin mutation in heterozygote form.
Results:
Ten of the 12 had their venous thrombosis successfully lysed and were discharged with an open venous system in the affected limb. The lysed venous segments remained patent in all ten, with normal venous valve function, as evaluated by Doppler reflux testing. The median follow-up time was five months (range 0-9 months). In one patient, the proximal thrombus (iliac) was lysed successfully, but the femoral vein could not be opened, probably because of an old thrombus remaining from a previous DVT episode. In the other patient, the venous thrombus was lysed successfully, but the vein rethrombosed after one day.
Discussion:
Catheter-directed thrombolysis appears feasible in patients with recent proximal DVT and the short-term results are good in terms of venous patency and valve function. A randomised trial is necessary to test whether this treatment modality is superior to conventional anticoagulation therapy.