ORIGINAL ARTICLE   

Italian Journal of Vascular and Endovascular Surgery 2021 December;28(4):105-12

DOI: 10.23736/S1824-4777.21.01508-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

Emily N. KIRKHAM ^{1, 2} ✉, Guy HICKSON ^{2, 3}, Raymond RAMNARINE ^{2, 3}, David G. COOPER ^{1, 2}

¹ Vascular Department, Gloucestershire Royal Hospital, Gloucester, UK; ² Gloucester Hospitals NHS Foundation Trust, Gloucester, UK; ³ Department of Interventional Radiology, Gloucestershire Royal Hospital, Gloucester, UK

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.

KEY WORDS: Venous thrombosis; Thrombolytic therapy; Post-thrombotic syndrome