Local thrombolysis for the treatment of patients with proximal deep vein thrombosis of the leg

BACKGROUND: Standard anticoagulatn therapy for lower extremity DVT does not distinguish between proximal and distal veins. Catheter directed thrombolytic therapy is a new emerging aggressive option for suitable patients with proximal DVT. OBJECTIVES: Review of the literature and presentation of two patients in whom the procedure was successfully performed. PATIENTS AND METHODS: Two patients with lower extremity DVT involving the iliac and femoral veins were treated with catheter directed urokinase infusion in addition to conventional anticoagulant therapy. In both cases underlying venous stenoses were identified and treated by balloon angioplasty and insertion of metallic stents. Thrombolytic therapy was continued for 36-60 hours at a rate of 100,000 units per hour. RESULTS: Significant clinical and radiological improvement was obtained in both patients with restoration of centripetal venous flow in the deep venous system. No significant complication occurred. A persistent clinical benefit was seen at follow-up of 8 and 24 months respectively. CONCLUSIONS: Catheter directed thrombolytic therapy should be considered as adjuvant therapy for patients with acute proximal lower extremity DVT, in whom there are no contraindications. Underlying venous stenoses should be dilated and stented if necessary. Early restoration of venous flow results in rapid clinical improvement and may prevent the future development of post thrombotic syndrome.