Citation, DOI & article data
Catheter-directed thrombolysis (CDT) is an endovascular approach to the treatment of acute iliofemoral deep vein thrombosis. It involves the administration of a lytic agent directly into a thrombus.
- precise diagnosis of iliofemoral deep vein thrombosis
- first episode of acute iliofemoral DVT
- symptomatic patients
- onset of symptoms <14 days
- low bleed risk
- ambulatory patients with good functional capacity and acceptable life expectancy
- phlegmasia cerulea dolens
- cerebral disease
- previous ipsilateral DVT
- uncontrolled hypertension
- bleeding disorders
- isolated femoral-popliteal deep vein thrombosis should be managed with conventional anticoagulation therapy
Ultrasound-guided micropuncture technique of a deep vein of the lower limb is performed, usually the popliteal vein. There are a wide range of catheters and they usually have multiple holes employing a pulse-spray technique of the thrombolytic agent.
Recombinant tissue plasminogen activator (rt-PA) is the thrombolytic agent of choice, it has a half-life of 3-5 minutes and 90% first-pass elimination in the liver. This results in targeted activation of plasminogen on the clot with the intent to dissolve fibrin. Doses range between 1-2 mg/hr up to a total dose of 30 mg. Heparin is used to maintain venous patency.
Successful catheter-directed thrombolysis results in a patent vein on venogram, spontaneous outflow of injected contrast, and disappearance of venous collaterals.
So far studies have shown no mortality or pulmonary embolism associated with catheter-directed thrombolysis. Major bleeding rates are 1-2% while minor bleeding was found to be <25%.
- 1. Meissner M, Gloviczki P, Comerota A et al. Early Thrombus Removal Strategies for Acute Deep Venous Thrombosis: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2012;55(5):1449-62. doi:10.1016/j.jvs.2011.12.081 - Pubmed
- 2. Kahn S, Comerota A, Cushman M et al. The Postthrombotic Syndrome: Evidence-Based Prevention, Diagnosis, and Treatment Strategies. Circulation. 2014;130(18):1636-61. doi:10.1161/cir.0000000000000130 - Pubmed