Preservation of Venous Valve Function after Catheter-
Directed and Systemic Thrombolysis for Deep Venous
M. K. Laiho,1*A. Oinonen,2N. Sugano,2V.-P. Harjola,1A. L. Lehtola,2W.-D. Roth,3
P. E. Keto3and M. Lepa ¨ntalo2
1Division of Emergency Care, Department of Medicine,2Department of Vascular Surgery, and3Department of
Radiology, Helsinki University Central Hospital, Haartmaninkatu 4, PL 340, 00029 HUS, Helsinki, Finland
Objectives. 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.
Patients. Thirty-two patients treated either with systemic (16) or catheter-directed local thrombolysis (16) for massive
iliofemoral thrombosis were identified from the hospital registry.
Methods. 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.
Results. Valvular competence was preserved in 44% of patients treated with catheter-directed thrombolysis compared with
13% of those treated with systemic thrombolysis (p ¼ 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 ¼ 0.03, Chi
squared). Reflux in any superficial vein was observed in 25% vs. 63% of the patients, respectively (p ¼ 0.03, Chi squared).
There were significantly more patients with venous insufficiency of classes C0-1 in the group treated with catheter-directed
Conclusion. In this clinical series venous valvular function was better preserved after iliofemoral DVTwhen treated with
Key Words: Deep venous thrombosis; Catheter-directed thrombolysis; Systemic thrombolysis; Postthrombotic syndrome;
Approximately two-thirds of patients with iliofemoral
deep venous thrombosis (DVT) will develop post-
thrombotic syndrome (PTS).1–3Appearance of symp-
toms of PTS usually occurs within 1–5 years of the
acute thrombosis, in most of the patients they appear
within the first 2 years.3,4The development of clinical
signs of PTS is preceded by venous valvular
Standard treatment of acute DVT consists of antic-
oagulation with unfractionated or low molecular
weight heparin followed by oral anticoagulants. The
goal is to prevent the extension of thrombus, pulmon-
ary embolism as well as valvular damage. However,
PTS is reported to occur more frequently in patients
treated with heparin alone compared to patients
treated with the thrombolytic drug streptokinase.5–7
Rapid thrombolysis seems to be important in preser-
ving valve function.8,9Furthermore a lower incidence
of PTS has been seen in patients treated with
recombinant tissue-type plasminogen activator (rt-PA
or alteplase), achieving greater than 50% of lysis.10,11
The thrombolytic drug streptokinase may offer more
complete lysis than standard treatment.12In a recent
controlled trial systemic thrombolytic therapy both
streptokinase and urokinase, reduced postthrombotic
disability compared with conventional therapy but at
the expense of a serious increase in major bleeding
events and pulmonary emboli.13Catheter-directed
techniques allow delivery of thrombolytic drug within
the thrombus with the aim of targeted and complete
lysis whist using far lower doses of the drug. In the
case of residual stenosis after lysis, these can often be
treated by transluminal venous balloon angioplasty
Eur J Vasc Endovasc Surg 28, 391–396 (2004)
doi: 10.1016/j.ejvs.2004.06.007, available online at http://www.sciencedirect.com on
*Corresponding author. Mia K. Laiho, MD, Department of Medicine,
Helsinki University Central Hospital, Haartmaninkatu 4, PL 340,
00029 HUS, Helsinki, Finland.
q 2004 Elsevier Ltd. All rights reserved.
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Accepted 7 June 2004
Available online 29 July 2004
M. K. Laiho et al.
Eur J Vasc Endovasc Surg Vol 28, October 2004