Long-term results after ultrasound-assisted catheter-directed thrombolysis for acute iliofemoral thrombosis

Background and objective Standard conservative proximal phlebothrombosis (deep vein thrombosis, DVT) treatment is associated with a high incidence of postthrombotic syndrome (PTS) between 40-70%. Alternatively, in individual cases surgical thrombectomy or interventional recanalization for avoidance of PTS can be considered. The aim of our study was to investigate the effectiveness of early intervention using ultrasound-assisted catheter-directed thrombolysis (UACDT) with the EKOS Endowave system in the long term. Methods In a single center retrospective study the incidence of PTS was examined according to the Villalta score and assessment of the disease-specific quality of life using the VEINS-QQL in 42 DVT patients (mean age 49.9 +/- 18.1 years) who underwent UACDT for iliofemoral thrombosis between July 2011 and November 2019. Results In 40 patients (95.2%) UACDT was performed successfully with recanalization of the iliofemoral veins with an average duration of lysis 56.5h (SD +/- 17.2h). Of the patients 22 (52.4%) completed the survey after a mean period of 50.4 months (+/- 30.9 months). The PTS rate was 27.3% (6 patients). Duplex ultrasound revealed patency of the venous system in 80% of the patients. Conclusion Early thrombus removal using UACDT in severe proximal DVT is associated with low PTS rates in the long term and can improve disease-specific quality of life in these patients; however, due to the risk of bleeding complications, the indications should continue to be critically viewed.