What is the success rate of percutaneous transcatheter treatment for deep venous thrombosis (DVT)?

Updated: Oct 30, 2020
  • Author: Donald Schreiber, MD, CM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

Success rates with catheter-directed thrombolytics vary depending on the age of the thrombus and the proximity to the inferior vena cava. Success with thrombolytic use in acute iliofemoral venous thrombosis has been reported to be 80-85%, with 1-year patency at 60-65%. Major bleeding complication rates vary from 5-11%; most bleeding occurs at the puncture site. [6, 7]

A prospective registry of 287 patients treated with a mean 53-hour infusion of urokinase-type plasminogen activator (uPA) showed anatomic success in 83%. About 34% of patients received adjunctive stent placement for underlying lesions. Major bleeding and rethrombosis were observed in 11% and 25% of patients, respectively, at 30-day follow-up. [7, 8]

Three studies demonstrated improved long-term venous function after catheter-directed thrombolysis versus anticoagulation alone. Two showed a decrease in reflux or symptoms from 41-70% to 11-22%. In a retrospective case-control study, quality-of-life scores (including stigmata, health distress, physical function, and symptoms) were superior at 22-month follow-up after catheter-directed thrombolysis with anticoagulation than after anticoagulation alone. [9]

The transcatheter approach facilitates the diagnosis of predisposing anatomic lesions or anomalies. In patients with iliofemoral DVT, catheter-directed thrombolysis was successful for recanalization in 92-100% of patients, and it revealed an underlying lesion in 50-66%. Treatment of these stenoses with angioplasty and stent placement reestablished unobstructed flow and achieved a prompt clinical response. Studies with 2-year follow-up documented a 5-11% incidence of valvular incompetence.


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