A ten-year experience of thrombolysis for lower limb ileo-femoral DVTs

BACKGROUND: Catheter-directed thrombolysis (CDT) for deep vein thrombosis (DVT) can reduce rates of post-thrombotic syndrome (PTS). We report our experience with CDT.METHODS: Consecutive patients undergoing CDT for acute proximal lower-limb DVTs from 2009-2019 were recruited. Eligibility criteria were utilized to decide a patient’s fitness for CDT. Patient demographics, complications of CDT and post-CDT stenting outcomes were collected. The Villalta Score was collected by telephone consultation between May-July 2019.RESULTS: Thirty-seven patients were thrombolyzed. Median follow-up was 63 months (12-115 months). Mean age was 48 (18-75). Fourteen patients had May-Thurner Syndrome. There was one death following CDT; secondary to multi-organ failure from chemotherapy for acute myeloid leukemia. No other immediate complications of CDT occurred. Fourteen patients (37.8%) had venous stenting; stents were patent in all initial duplex scans. Twenty-eight patients were contactable; the median Villalta Score was 0 (range 0-15, N.=2 score >5). Only two patients (7.1%) developed PTS.CONCLUSIONS: Our CDT burden for lower-limb DVTs is low. However, long-term outcomes are good, with only 7.1% developing PTS, suggesting cautious use of CDT with selective stenting in an appropriate population can produce satisfactory short- and longer-term outcomes. In light of conflicting evidence and more recent developments in technology, the long-term benefit of intervention for iliofemoral DVT over traditional conservative management warrants further investigation.