Clinical efficacy and safety of catheter-guided thrombolysis in patients with deep vein thrombosis of the lower extremities

Objective: to assess clinical efficacy and safety of catheter-guided thrombolysis (CGT) in patients with acute deep vein thrombosis (DVT) of the lower extremities. Materials and methods. This study included 28 patients (10 men and 18 women aged between 31 and 70 years). The inclusion criteria were as follows: primary DVT confirmed by duplex ultrasound scanning (DUS), ≤ 14 days from the disease onset, and no contraindications to thrombolytic therapy. Before CGT, all patients underwent instrumental and laboratory examination, which included DUS of the veins of the lower extremities, contrast-enhanced phlebography, and measurement of D-dimer in peripheral blood. Short-term outcomes were evaluated using follow-up phlebography performed after the completion of CGT procedure. Long-term outcomes were evaluated in all 28 patients 12 months after the procedure. Preservation of primary patency and development of deep vein valvular insufficiency were assessed using DUS. The Villalta scale was used to diagnose post-thrombotic syndrome (PTS) and to estimate its severity. Results. CGT was technically effective in 24 patients (85.7%). Eight participants (28.6%) additionally underwent iliac vein stenting due to hemodynamically significant stenosis detected at follow-up phlebography. The analysis of long-term treatment outcomes demonstrated that primary patency was preserved in 27 patients (96.4%). Seven individuals (25.1%) were found to have pathologic venous reflux. Nine patients (32.1%) developed PTS, but none of them had severe disease. Conclusion. Our findings suggest high efficacy of CGT in the treatment of DVT. The use of this procedure in early-stage DVT significantly mitigates clinical manifestations of acute venous insufficiency, prevents PTS or alleviates its symptoms.