Catheter-Directed Thrombolysis in Acute Iliofemoral Deep Vein Thrombosis with or without Stenting: A Case Series
Iliofemoral deep vein thrombosis (IFDVT) is a potentially devastating condition comprising a quarter of all cases of lower extremity DVT. It can lead to serious consequences such as pulmonary embolism, limb malperfusion, and post-thrombotic syndrome (PTS), which is a chronic sequela of IFDVT. We herewith present 18 IFDVT cases managed with catheter-directed thrombolysis at our hospital. Nine of these patients underwent stenting of the involved iliac veins. The remaining 9, who did not receive stenting, had a residual stenosis of more than 50% in the common femoral or iliac veins following the procedure. Based on a final residual stenosis of less than 50% in the iliac veins, we had 9 successful (patients with stenting) and 9 unsuccessful procedures (patients without stenting). In subsequent follow-ups at a median follow-up of 39.5 months, using the Villalta score, while only 2 out of the 9 patients who underwent stenting suffered PTS, 4 patients among the other 9 patients comprising the non-stenting group developed PTS. Our results support the notion that stenting might have a role in decreasing the PTS risk in patients undergoing catheter-directed thrombolysis.
David Liu, Erica Peterson, James Dooner. Diagnosis and management of iliofemoral deep vein thrombosis: clinical practice guideline. CMAJ November 17, 2015 187 (17) 1288-1296; DOI: https://doi.org/10.1503/cmaj.141614
J. Stephen Jenkins, Paul Michael. Deep Venous Thrombosis: An Interventionalist's Approach. Ochsner J. 2014 Winter; 14(4): 633–640.
T. Raymond Foley, Stephen W. Waldo, Ehrin J. Armstrong. Iliofemoral Deep Vein Thrombosis, Expert Analysis. American College of Cardiology Nov 24, 2015.
Accessed online at
Mazzolai L, Aboyans V, Ageno W, et al. Diagnosis and Management of Acute Deep Vein Thrombosis: A Joint Consensus Document From the European Society of Cardiology Working Groups of Aorta and Peripheral Vascular Diseases and Pulmonary Circulation and Right Ventricular Function. Eur Heart J 2017;Feb 17
David M. Liu, Behrang Homayoon, John Chung. The ABCs of Iliofemoral DVT. Understanding the continuum of care through a team-based approach. July 2017 Supplement
T. Raymond Foley, Stephen W. Waldo, Ehrin J. Armstrong. Iliofemoral Deep Vein Thrombosis. Nov 24, 2015 Expert Analysis
Thijs W, Rabe KF, Rosendaal FR, Middeldorp S. Predominance of left-sided deep vein thrombosis and body weight. J Thromb. Haemost 2010; 8: 2083–4
Kahn SR, Galanaud J-P, Vedantham S, Ginsberg JS. Guidance for the prevention and treatment of the post-thrombotic syndrome. Journal of Thrombosis and Thrombolysis. 2016;41:144-153. doi:10.1007/s11239-015-1312-5.
Vedantham S, Kahn SR, Goldhaber SZ, et al. Endovascular therapy for advanced post-thrombotic syndrome: Proceedings from a multidisciplinary consensus panel. Vascular medicine (London, England). 2016;21(4):400-407. doi:10.1177/1358863X16650747.
Fleck D, Albadawi H, Shamoun F, Knuttinen G, Naidu S, Oklu R. Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations. Cardiovascular Diagnosis and Therapy. 2017;7(Suppl 3):S228-S237. doi:10.21037/cdt.2017.09.15.
Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Kahn SR, Shrier I, Julian JA, Ducruet T, Arsenault L, Miron MJ, Roussin A, Desmarais S, Joyal F, Kassis J, Solymoss S, Desjardins L, Lamping DL, Johri M, Ginsberg JS. Ann Intern Med. 2008 Nov 18; 149(10):698-707.
Enden T, Haig Y, Kløw NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomized controlled trial. Lancet 2012;379:31-8.
Comerota AJ. Quality-of-life improvement using thrombolytic therapy for iliofemoral deep venous thrombosis. Rev Cardiovasc Med 2002;3 Suppl 2:S61-7.
Vedantham, S., Goldhaber, S., Julian, J., Kahn, S., Jaff, M., Cohen, D., Magnuson, E., Razavi, M., Comerota, A., Gornik, H., Murphy, T., Lewis, L., Duncan, J., Nieters, P., Derfler, M., Filion, M., Gu, C., Kee, S., Schneider, J., Saad, N., Blinder, M., Moll, S., Sacks, D., Lin, J., Rundback, J., Garcia, M., Razdan, R., VanderWoude, E., Marques, V. and Kearon, C. (2017). Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis. New England Journal of Medicine, 377(23), pp.2240-2252.