Preservation of Venous Valve Function after Catheter-Directed and Systemic Thrombolysis for Deep Venous Thrombosis

Department of Oral Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
European Journal of Vascular and Endovascular Surgery (Impact Factor: 2.49). 11/2004; 28(4):391-6. DOI: 10.1016/j.ejvs.2004.06.007
Source: PubMed


The aim of the study was to assess venous reflux and the obstruction pattern after catheter-directed and systemic thrombolysis of deep iliofemoral venous thrombosis.
Thirty-two patients treated either with systemic (16) or catheter-directed local thrombolysis (16) for massive iliofemoral thrombosis were identified from the hospital registry.
Clinical evaluation at follow up was based on the CEAP classification and disability score. Reflux was assessed by colour duplex ultrasonography and standardised reflux testing. A vascular surgeon blinded to treatment established the clinical status of the lower limb following the previous DVT.
Valvular competence was preserved in 44% of patients treated with catheter-directed thrombolysis compared with 13% of those treated with systemic thrombolysis (p=0.049, Chi squared). Reflux in any deep vein was present in 44% of patients treated by catheter-directed lysis compared with 81% of patients receiving systemic thrombolysis (p=0.03, Chi squared). Reflux in any superficial vein was observed in 25% vs. 63% of the patients, respectively (p=0.03, Chi squared). There were significantly more patients with venous insufficiency of classes C0-1 in the group treated with catheter-directed thrombolysis.
In this clinical series venous valvular function was better preserved after iliofemoral DVT when treated with catheter-directed thrombolysis.

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    • "These include preventing recurrent ipsilateral DVT, modifying risk factors such as obesity, treating venous obstruction via stenting and angioplasty, and surgically repairing or replacing venous valves [7, 20, 47, 58, 71, 72]. Moreover, catheter, directed thrombolysis has also shown to improve valvular reflux and vein patency and is recommended for selected patients diagnosed with iliofemoral DVT by practice guidelines [73–75]. "
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    ABSTRACT: Background. Postthrombotic syndrome (PTS) is a burdensome and costly complication of deep vein thrombosis (DVT). Up to 50% of patients with DVT will develop the disease within two years following the diagnosis of acute DVT. Various risk factors for developing PTS have been identified and different modalities have been used to prevent its development. Compression stockings have been studied for the prevention of PTS in patients diagnosed with proximal DVT. Methods. MEDLINE and EMBASE databases were searched to identify relevant original articles. Results. Several trials including two metaanalyses have examined the role of compression stockings for the prevention of PTS. Although most trials showed significant reduction in the development of PTS with the use of compression stockings, limitations in study design prevent the generalizability of the data. Two studies supported an individualized tailored duration especially in patients at low risk for developing the syndrome. A randomized double-blind placebo-controlled trial involving 800 patients is currently ongoing and may confirm the results of older studies. Conclusions. Clinical trials support the use of compression stockings in patients diagnosed with proximal DVT for the prevention of PTS.
    01/2012; 2012(1):694851. DOI:10.1155/2012/694851
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    • "The best candidates for thrombolytic therapy are young, healthy patients with primary UEDVT, patients with symptomatic SVC syndrome, and those who require preservation of a central venous catheter.34 Some trials demonstrated that systemic thrombolytic therapy provided a better lysis with reduction in post-thrombotic syndrome.54–61 "
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    ABSTRACT: Almost 4% of all patients with venous thrombosis have upper extremity deep vein thrombosis (UEDVT) and the incidence of UEDVT increases over time. The frequency of post-thrombotic syndrome (PTS) after UEDVT is not low and upper extremity PTS is a potentially major morbidity that adversely affects quality of life, particularly if the dominant arm is involved. We discuss briefly the role of thrombolytic therapy in the treatment of upper extremity deep vein thrombosis and also the role of systemic thrombolysis in selected patients.
    ARYA Atherosclerosis 03/2011; 7(1):40-6.

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