Treatment of Acute Iliofemoral Deep Vein Thrombosis: Does Catheter Directed Thrombolytic Therapy Change Outcomes
Abstract
Ayman M Fakhry, El-Sayed A Abd El-Mabood, Waleed A Sorour, Ayman M Abdelmofeed, Taher H Elwan, Ahmed Fouad Ahmed Mohamed E Abd Ellatief, Saied ELMOKKADEM
Background: Iliofemoral deep vein thrombosis (DVT) is associated with severe post-thrombotic morbidity when treated with anticoagulation alone. Catheter- directed thrombolysis (CDT) allows early removal of thrombus and reduces valvular reflux and Post-thrombotic Syndrome (PTS).
Patients and methods: This prospective randomized multi-center controlled two- arm blind study was conducted in 6 centers on 252 patients with iliofemoral DVT. Patients were randomly allocated by using simple random allocation cards method into two groups; Group (A): CDT followed by oral anticoagulation (N=126 (50%)), Group (B): Standard DVT therapy (N=126 (50%)). Follow-up was for 24 months.
Results: Patients of group (A) significantly complained less pain at 10 & 30 days (P-Value: 0.02 & 0.04 respectively). Also there was significant decrease in leg circumference in group (A) at 10 & 30 days (P-Value: 0.001 & 0.03 respectively). Patency of iliac vein segment was significantly higher in group (A) during the 24 months follow up (P-Value <0.001 (HS)). Patients in group (A) developed less PTS at six months, at one year and at two years (P-Value: 0.024, 0.017 and 0.035 respectively). Better Quality of life was observed in group (A) (P-Value: 0.003).
Conclusion: Addition of catheter-directed thrombolysis in the treatment of acute iliofemoral DVT; was safe and tolerated by most of the patients with better effect to reduce leg pain & circumference. It was considered a protecting weapon to prevent post-thrombotic syndrome and so improve quality of life and was related to achievement of higher iliac vein patency and less reflux.