Catheter-directed thrombolysis in the treatment of iliofemoral venous thrombosis. A review

Abstract

Patients with acute iliofemoral venous thrombosis treated with anticoagulation only are at high risk of developing postthrombotic syndrome. Immediate removal of the thrombus by catheter-directed thrombolysis (CDT) may increase patency, prevent damage of the venous valves, and prevent reflux and PTS. However, the indications for its use are not well established because of lack of data from randomised controlled trials. Aim of this review was to describe the treatment of iliofemoral venous thrombosis with CDT and to evaluate the effectiveness of this therapy. An electronic literature search was performed in the PubMed, EMBASE, and Cochrane Library on the largest studies (more than 40 legs treated) concerning catheter-directed thrombolysis of iliofemoral venous thrombosis. A total of 236 publications were identified but only 11 studies met the inclusion criteria with a total of 979 lower limbs. Early patency from 6-12 months was 60-95% and patency after six years was 82%, reported in one study. Mortality of up to 1% was reported in two studies. Major complications such as hematomas requiring surgery were observed in 1-11% whereas minor complications, mostly bleeding from the puncture site, were seen in up to 18%. CDT seems to be effective in the treatment of iliofemoral venous thrombosis and results are promising. Studies are, however, characterized by heterogeneity and are difficult to compare. Only one study reports long-term follow-up and incidence of postthrombotic syndrome is not reported. Further studies regarding the use of CDT, both alone and in combination with mechanical thrombectomy are needed.