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Updated: May 31, 2026

An In vitro System to Gauge the Thrombolytic Efficacy of Histotripsy and a Lytic Drug
07:50

An In vitro System to Gauge the Thrombolytic Efficacy of Histotripsy and a Lytic Drug

Published on: June 4, 2021

Optimizing catheter-directed thrombolysis access and predicting post-thrombotic syndrome in acute entire-limb DVT: a

Cheng Qian1, Guo-Ping Chen1, Tao Wang1

  • 1Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.

Frontiers in Cardiovascular Medicine
|May 29, 2026
PubMed

Insights

Choosing the right catheter-directed thrombolysis (CDT) access for acute deep vein thrombosis (DVT) is crucial. Antegrade approaches improve thrombus clearance, but comprehensive hemodynamic restoration is key for preventing post-thrombotic syndrome (PTS).

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Cardiovascular Medicine

Background:

  • Optimal catheter-directed thrombolysis (CDT) access for acute entire-limb deep vein thrombosis (DVT) remains debated.
  • Comparing technical and clinical outcomes of different CDT access strategies is essential.
  • Predicting post-thrombotic syndrome (PTS) risk requires understanding hemodynamic and procedural factors.

Purpose of the Study:

  • To compare technical and clinical outcomes of three CDT access approaches for acute entire-limb DVT.
  • To develop a prognostic nomogram for predicting PTS after CDT.
  • To identify independent predictors of PTS based on hemodynamic and procedural variables.

Main Methods:

  • Retrospective analysis of 172 patients with acute entire-limb DVT undergoing CDT.
  • Comparison of contralateral femoral vein access (CFVA), ipsilateral popliteal vein access (IPVA), and ipsilateral calf venous access (ICVA).
  • Utilized LASSO-Cox regression to identify PTS predictors and construct a prognostic nomogram.

Main Results:

  • Antegrade approaches (IPVA, ICVA) showed superior thrombus clearance and inflow patency compared to CFVA.
  • The 2-year PTS incidence was significantly higher with CFVA (59.8%) versus IPVA (38.2%) and ICVA (41.2%).
  • Poor inflow/outflow patency and deep femoral vein axial transformation were independent PTS risk factors; the nomogram showed excellent discrimination (C-index=0.82).

Conclusions:

  • Antegrade CDT access optimizes early thrombus resolution in acute entire-limb DVT.
  • Long-term PTS prevention depends on comprehensive hemodynamic restoration, not solely the access site.
  • The developed nomogram is a valuable tool for individualized PTS risk stratification and clinical decision-making.
Abstract

Keywords:
catheter-directed thrombolysisdeep vein thrombosispost-thrombotic syndromerisk factorsvenous access

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