Deep vein thrombosis: a mininvasive locoregional thrombolytic treatment

Locoregional thrombolytic therapy has emerged in the last years as the treatment of choise for iliofemoral deep vein thrombosis, preserving the structural and functional integrity of vein walls. We studied the efficacy and complication rates of direct regional thrombolytic therapy in acute venous thrombosis of lower extremities.

Between January 2002 and March 2007, 8 selected patients with acute extensive and symptomatic iliofemoral or femoral-popliteal venous thrombosis were treated with flow-direct regional thrombolytic therapy. We used a direct regional infusion of urokinase into the deep venous system ( 100.000 U al presentation, then 75.000 U/ h) from an ipsilateral dorsal foot vein . Simultaneously the superficial venous system was collapsed with elastic limb compression while administering subtherapeutic heparin doses of 300-400 U/h. All patients underwent routine venous duplex imaging at day 1, 2, 30 and after 3, 6 and 12 months. Data including clinical conditions and laboratory values (fibrinogen, hematocrit, haemoglobin, platlets and prothrombin time) were obtained throughout the infusion time. Results. Procedural success was achieved in all patients (100%). Complete recanalization, patency and continence of venous system documented at the echocolorDoppler control, were obtained in 48 hours, with symptom remission. Mean infusion time was 37.5 hours (28-48 hours). Neither major bleeding complications nor pulmonary embolisms occurred during the treatment. At day 30 venous patency and incontinence and long-term symptom resolution were achieved in all patients, as well as at 3, 6 and 12 months.

Loco-regional thrombolytic therapy is safe and effective in selected patients and may become a well-founded alternative in the treatment of acute deep vein thrombosis of lower extremities and in the prevenction of its complications .