Catheter Directed Thrombolysis in Iliofemoral Deep Vein Thrombosis
Abstract
Background Iliofemoral deep vein thrombosis (IFDVT) is associated with more severe outflow obstruction which results in more severe DVT symptoms and late clinical sequelae. Despite anticoagulation therapy, IFDVT patients is still at risk to develop postthrombotic syndrome (PTS). Recent studies found that additional catheter-directed thrombolytic therapy may offer advantages in reducing PTS and maintaining venous patency. Several ongoing multi-center randomized controlled trials are expected to evaluate safety and efficacy of CDT in IFDVT patients, and define who will benefit most.Case Illustration A 59-year-old male was presented with numbness, pain, and movement limitation in the left leg that were preceded by left leg swelling. Peripheral edema was found in both patient’s leg but more prominent on the left side. Dupplex sonography revealed extensive soft thrombus from left iliac vein to left tibialis vein. Initial anticoagulation therapy took no effect to the thrombus. Catheter-directed thrombolysis was performed and provided satisfactory symptoms resolution as well as thrombus dissolution.
Summary A case of iliofemoral DVT has been reported. The present therapeutic strategy of anticoagulation therapy has not been proven to prevent PTS. CDT is an effective way in achieving clot lysis in acute thrombosis, and this may help to prevent PTS and subsequent ulceration. The potential benefits of therapy must be weighed carefully against the risk of bleeding. There are several ongoing RCTs that are awaited to help provide evidence on functional outcome after CDT and define who will benefit most.
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References
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2. White RH. The epidemiology of venous thromboembolism. Circulation 2003;107(SUPPL. 23):4-9.
3. Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: A scientific statement from the american heart association. Circulation 2011;123(16):1788-1830.
4. Stanley J, Veith F, Wakefield T. Current Therapy in Vascular and Endovascular Surgery. Fifth Ed. Philadephia: Elsevier Inc.; 2014.
5. Douketis JD, Crowther MA, Foster GA, Ginsberg JS. Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis? Am. J. Med. 2001;110(7):515-519.
6. Kahn SR. Determinants and Time Course of the Postthrombotic Syndrome after Acute Deep Venous Thrombosis. Ann. Intern. Med. 2008;149(10):698.
7. Elsharawy M, Elzayat E. Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis. A randomised clinical trial. Eur. J. Vasc. Endovasc. Surg. 2002;24(3):209-14.
8. Enden T, Kløw NE, Sandvik L, et al. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: Results of an open randomized, controlled trial reporting on short-term patency. J. Thromb. Haemost. 2009;7(8):1268-1275.
9. Casey ET, Murad MH, Zumaeta-Garcia M, et al. Treatment of acute iliofemoral deep vein thrombosis. J. Vasc. Surg. 2012;55(5):1463-1473.
10. Bækgaard N, Broholm R, Just S, Jørgensen M, Jensen LP. Long-Term Results using Catheter-directed Thrombolysis in 103 Lower Limbs with Acute Iliofemoral Venous Thrombosis. Eur. J. Vasc. Endovasc. Surg. 2010;39(1):112-117.
Published
2016-05-02
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How to Cite
P. Apriansyah, F., & Adiarto, S. (2016). Catheter Directed Thrombolysis in Iliofemoral Deep Vein Thrombosis. Indonesian Journal of Cardiology, 35(4), 278-84. https://doi.org/10.30701/ijc.v35i4.496
Section
Case Reports
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