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Catheter-directed thrombolysis for iliofemoral deep vein thrombosis

J H Saunders1, P H Arya, S Abisi

  • 1Department of Vascular and Endovascular Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK. jhsaunders@doctors.org.uk

The British Journal of Surgery
|May 23, 2013
PubMed

Insights

International guidelines suggest catheter-directed thrombolysis (CDT) for iliofemoral deep vein thrombosis (DVT). This study estimates a significant increase in demand for CDT, impacting hospital resources and patient referrals.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Thrombosis Management

Background:

  • International guidelines now recommend catheter-directed thrombolysis (CDT) for select patients with symptomatic iliofemoral deep vein thrombosis (DVT).
  • Assessing the impact of these recommendations on healthcare workload is crucial for resource planning.

Purpose of the Study:

  • To estimate the potential increase in workload for vascular units due to the recommended use of CDT for iliofemoral DVT.
  • To evaluate the number of patients eligible for CDT based on current guidelines.

Main Methods:

  • A retrospective review of DVTs diagnosed between August 2010 and February 2012 was conducted using a radiology database.
  • Two independent clinicians applied current international guidance (NICE and ACCP) to determine CDT eligibility in patients with iliofemoral DVT.

Main Results:

  • Out of 563 DVT cases, 128 had iliofemoral DVT. Of these, 53 patients (4.4 per 100,000 per year) were deemed eligible for CDT.
  • Only 8 of the 53 eligible patients were referred for treatment, and all underwent successful CDT with critical care monitoring.

Conclusions:

  • Vascular services must prepare for a substantial rise in CDT demand for iliofemoral DVT.
  • This increased demand will necessitate adjustments in inpatient bed allocation, interventional radiology capacity, critical care services, and interhospital referral processes.
Abstract

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