Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis.

Abstract

To evaluate the efficacy of catheter-directed thrombolysis with urokinase in treating symptomatic iliofemoral deep venous thrombosis (DVT). Twenty-one consecutive patients with iliofemoral DVT underwent treatment for 27 affected limbs (acute DVT, n = 20; chronic DVT, n = 7). The average urokinase dose was 4.9 million IU (range, 1.4 million to 16.0 million IU) infused over an average of 30 hours (range, 15-74 hours). Lysis was complete in 18 (72%), partial in five (20%), and not achieved in two (8%) of 25 treated limbs. Two chronically occluded iliac veins could not be crossed with a guide wire and did not receive urokinase. Sixteen limbs had underlying venous stenoses (> 50%) that were treated with angioplasty (n = 2) or angioplasty and stent placement (n = 14). There were no major complications or clinically detectable pulmonary emboli. The technical and clinical success rates were 85%. This initial experience suggests that catheter-directed thrombolysis with urokinase for treatment of symptomatic iliofemoral DVT is safe and effective.