What is the efficacy and safety of percutaneous transcatheter treatment for deep venous thrombosis (DVT)?

Updated: Dec 10, 2019
  • Author: Donald Schreiber, MD, CM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

The Society of Interventional Radiology (SIR) published a position paper supporting the adjunctive use of catheter-directed thrombolysis in addition to anticoagulant therapy for carefully selected patients with acute iliofemoral DVT. The authors evaluated this therapeutic option in the context of the major therapeutic goals for the treatment of DVT: (1) provision of early symptom relief, (2) prevention of PTS, and (3) prevention of PE. [17]

The position statement cites a number of comparative studies that support the use of catheter-directed thrombolysis to prevent PTS and provide rapid symptom relief. The authors explain that the natural history of iliofemoral DVT is different than that of isolated femoropopliteal DVT. In the latter group, recanalization and collateral venous blood flow limit the degree of PTS. However, in the iliac veins, adequate recanalization is unlikely and collateral venous blood flow is minimal. This leads to persistent venous outflow obstruction and an increased risk of PTS.

Long-term studies of patients with iliofemoral DVT reported a 44% incidence of venous claudication at 5-year follow-up with standard anticoagulant therapy alone. Furthermore, the rate of recurrence of DVT is twice as high in patients with an iliofemoral DVT than in those with more distal, femoropopliteal DVT. The authors referenced a meta-analysis that demonstrated a 90% success rate with catheter-directed thrombolysis for thrombus removal, as well as a case-control study that reported a decreased incidence of PTS compared with anticoagulant therapy alone.

The SIR recognized that the main risk of adjunctive catheter-directed thrombolysis is bleeding. Their pooled review of 19 published studies reported an 8% incidence of major bleeding (mostly at the catheter insertion site) and an intracranial bleeding rate of only 0.2%, which is less than that reported for systemic thrombolytic therapy. However, the range of major bleeding risk in the studies reviewed was actually 0-24%. The incidence of PE was 1%, which is also less than the incidence of PE complicating standard anticoagulant therapy.

However, the authors conceded that no prospective, randomized study has yet been conducted to compare catheter-directed thrombolysis with standard anticoagulant therapy for iliofemoral DVT. In conclusion, the SIR affirmed that the available evidence defended a clinical benefit of catheter-directed thrombolysis in the specific subgroup of patients with iliofemoral DVT, limb-threatening disease, and low bleeding risk. [18]


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