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A Retrospective Study Comparing 2 Approaches to Catheter-Directed Thrombolysis for Acute Deep Venous Thrombosis

Haiyang Wang1, Xiaotong Qi1, Yikuan Chen1

  • 1Department of Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.

Annals of Vascular Surgery
|March 9, 2018
PubMed

Insights

Catheter-directed thrombolysis (CDT) effectively treats acute lower-extremity deep venous thrombosis (LEDVT). The anterior tibial vein approach (ATVA) offers a safer alternative to the popliteal vein approach (PVA), with fewer complications.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Thrombosis Management

Background:

  • Acute lower-extremity deep venous thrombosis (LEDVT) poses significant clinical challenges.
  • Catheter-directed thrombolysis (CDT) is a key treatment modality for extensive LEDVT.
  • Optimizing CDT approaches is crucial for improving patient outcomes.

Purpose of the Study:

  • To compare the clinical efficacy and safety of CDT using the anterior tibial vein approach (ATVA) versus the popliteal vein approach (PVA).
  • To evaluate complication rates and long-term outcomes, including post-thrombotic syndrome (PTS) and venous insufficiency.

Main Methods:

  • A study involving 63 patients with unilateral acute extensive LEDVT.
  • Patients were divided into two groups: CDT via PVA (36 patients) and CDT via ATVA (27 patients).
  • Key metrics included thrombus score, limb circumference, complication rates, thrombolytic agent administration, and 1-year follow-up for PTS and venous insufficiency.

Main Results:

  • Both ATVA and PVA groups showed significant thrombus reduction (P < 0.001).
  • The ATVA group exhibited a lower limb circumference difference below the knee (P = 0.029) and fewer complications, particularly sheath bleeding (P = 0.025).
  • No significant differences were observed in detumescence, thrombolytic rates, or thrombolytic times between groups. Long-term PTS and venous insufficiency rates were comparable.

Conclusions:

  • CDT is an effective and safe treatment for acute LEDVT.
  • The ATVA is a feasible and effective approach for CDT, demonstrating a lower incidence of complications compared to the PVA.
  • ATVA may be a preferred route for CDT in select LEDVT cases.
Abstract

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