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Semin intervent Radiol 2001; 18(2): 145-154
DOI: 10.1055/s-2001-15176
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Catheter-Directed Thrombolytic Therapy for Iliofemoral Venous Thrombosis in the Posturokinase Era

Charles P. Semba, Mahmood K. Razavi, Stephen T. Kee, Daniel Y. Sze, Michael D. Dake
  • Cardiovascular-Interventional Radiology, Stanford University School of Medicine, Stanford, California
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Publication History

Publication Date:
31 December 2001 (online)

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ABSTRACT

Iliofemoral venous thrombosis represents approximately 5% of lower-extremity deep vein thrombosis (DVT). Clinical features often include massive unilateral leg edema, pain, and cyanosis. Conventional therapy with anticoagulation is often inadequate for relieving acute symptoms, and patients are at high risk for developing sequelae of post-thrombotic syndrome (PTS) (chronic leg pain, edema, hyperpigmentation, and venous claudication). Prior to 1999, urokinase was the dominant drug for venous thrombolytic therapy. Catheter-directed thrombolytic therapy using alteplase (recombinant tissue plasminogen activator [rt-PA]) has emerged as a viable alternative in patients with no contraindications to thrombolytic therapy. Many of these patients, especially young otherwise healthy women with acute left leg pathology, have a potentially curable underlying anatomic lesion (iliac vein compression syndrome [IVCS]) amenable to percutaneous therapy. The purpose of this article is to review the indications, techniques, and outcomes related to endovascular management of iliofemoral DVT.

KEYWORD

Deep vein thrombosis - thrombolytic therapy - anticoagulation

REFERENCES

  • 1 Moser K M. Pulmonary thromboembolism. In: Isselbacher XJ, Braunwald E, Wilson JD, Martin JB, Fauci A, Kasper W, eds. Harrison's Principles of Internal Medicine, 13th ed New York: McGraw-Hill 1994: 1214-1220
    Google Scholar
  • 2 Koopman M MW, Prandoni P, Piovella F. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular weight heparin administered at home.  N Engl J Med . 1996;  334 682-687
    CrossrefPubMedGoogle Scholar
  • 3 Agnelli G, Sonaglia F. Prevention of venous thromboembolism.  Thromb Res . 2000;  97 V49-V62
    CrossrefPubMedGoogle Scholar
  • 4 Levine M, Gent M, Hirsh J. A comparison of low-molecular weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep vein thrombosis.  N Engl J Med . 1996;  334 677-681
    CrossrefPubMedGoogle Scholar
  • 5 Meissner M H, Manzo R A, Bergelin R O, Markel A, Strandness D E. Deep venous insufficiency: the relationship between lysis and subsequent reflux.  J Vasc Surg . 1993;  18 596-605
    CrossrefPubMedGoogle Scholar
  • 6 Johnson B F, Manzo R A, Bergelin R O, Strandness D E. The relationship between changes in the deep venous system and the development of the postthrombotic syndrome after an acute episode of lower limb deep vein thrombosis: a one- to six-year follow-up.  J Vasc Surg . 1995;  21 307-312
    PubMedGoogle Scholar
  • 7 Welkie J F, Comerota A J, Katz M L. Hemodynamic deterioration in chronic venous disease.  J Vasc Surg . 1992;  16 733-740
    PubMedGoogle Scholar
  • 8 Comerota A J, Aldridge S. Thrombolytic therapy for acute deep vein thrombosis.  Semin Vasc Surg . 1992;  5 76-81
    PubMedGoogle Scholar
  • 9 Hill S L, Martin D, Evans P. Massive vein thrombosis of the extremities.  Am J Surg . 1989;  158 131-136
    CrossrefPubMedGoogle Scholar
  • 10 Okrent D, Messersmith R, Buckman J. Transcatheter fibrinolytic therapy and angioplasty for left iliofemoral venous thrombosis.  J Vasc Intervent Radiol . 1991;  2 195-197
    PubMedGoogle Scholar
  • 11 Semba C P, Dake M D. Iliofemoral deep venous thrombosis: aggressive therapy using catheter-directed thrombolysis.  Radiology . 1994;  191 487-494
    PubMedGoogle Scholar
  • 12 Grossman C, McPherson S. Safety and efficacy of catheter-directed thrombolysis for iliofemoral venous thrombosis.  Am J Roentgenol . 1999;  211 39-49
    PubMedGoogle Scholar
  • 13 Bjarnason H, Kruse J R, Asinger D A. Iliofemoral deep venous thrombosis: safety and efficacy outcome during 5-years of catheter-directed thrombolysis.  J Vasc Intervent Radiol . 1997;  8 405-418
    PubMedGoogle Scholar
  • 14 Mewissen M W, Seabrook G R, Meissner M H. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multi-center registry.  Radiology . 1999;  211 39-49
    CrossrefPubMedGoogle Scholar
  • 15 Van Breda A, Graor R A, Katzen B T, Risius B, Gillings D. The relative cost-effectiveness of urokinase versus streptokinase in the treatment of peripheral vascular disease.  J Vasc Intervent Radiol . 1991;  2 77-87
    PubMedGoogle Scholar
  • 16 Difficulties in Obtaining Sufficient Amounts of Urokinase. Rockville, MD: Center for Biologics Evaluation and Research, Public Health Service, Food and Drug Administration; December 11, 1998
    Google Scholar
  • 17 Important Drug Warning: Dear Healthcare Provider. Rockville, MD: Center for Biologics Evaluation and Research, Public Health Service, Food and Drug Administration; January 25, 1999 (Lett)
    Google Scholar
  • 18 Ouriel K, Veith F J, Sasahara A A. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators.  N Engl J Med . 1998;  16 1105-1111
    PubMedGoogle Scholar
  • 19 Ouriel K, Kandarpa K, Schuerr D M. Prourokinase versus urokinase for recanalization of peripheral occlusions, safety and efficacy: the PURPOSE trial.  J Vasc Intervent Radiol . 1999;  10 1083-1091
    PubMedGoogle Scholar
  • 20 Verhaege R, Stockyx L, Lacroix H, Vermylen J, Baert A L. Catheter-directed thrombolysis of iliofemoral vein thrombosis with use of rt-PA.  Eur Radiol . 1997;  7 996-1001
    CrossrefPubMedGoogle Scholar
  • 21 Semba C P. Venous thrombolysis in the post-urokinase era.  Tech Vasc Intervent Radiol . 2000;  3 1-11
    PubMedGoogle Scholar
  • 22 Semba C P. Thrombolytic therapy with use of alteplase (rt-PA) in peripheral arterial occlusive disease: review of the clinical literature. The Advisory Panel.  J Vasc Intervent Radiol . 2000;  11(2, Pt 1) 149-161
    PubMedGoogle Scholar
  • 23 Ouriel K, Gray B, Clair D G, Olin J. Complications associated with the use of urokinase and recombinant tissue plasminogen activator for catheter-directed peripheral arterial and venous thrombolysis.  J Vasc Intervent Radiol . 2000;  11 295-298
    PubMedGoogle Scholar
  • 24 McNamara T O, Chen J L, Temmins C J, Quinn B. Bleeding associated with intrathrombus infusions of rt-PA for peripheral arterial and venous occlusions.  J Vasc Intervent Radiol . 2000;  11(2, Pt 2) 288(Abst)
    PubMedGoogle Scholar
  • 25 McNamara T O, Aban K T, Quinn B, Hung R. Complications associated with use of rt-PA versus retavase during thrombolysis of peripheral arteries and veins.  J Vasc Intervent Radiol . 2000;  11(2, Pt 2) 301(Abst)
    PubMedGoogle Scholar
  • 26 Semba C P. Alteplase as an alternative to urokinase. Advisory Panel on Catheter-Directed Thrombolytic Therapy.  J Vasc Intervent Radiol . 2000;  11(2, Pt 1) 149-161
    PubMedGoogle Scholar
  • 27 Hasdai D, Holmes D R, Topol E J. Frequency and clinical outcome of cardiogenic shock during acute myocardial infarction among patients receiving reteplase or alteplase. Results from GUSTO-III. Global Use of Strategies to Open Occluded Coronary Arteries.  Eur Heart J . 1999;  20 128-135
    CrossrefPubMedGoogle Scholar
  • 28 Massel D. Evidence-based medicine and reteplase: inductive arguments over deductive reasoning.  Can J Cardiol . 1999;  15 999-1005
    PubMedGoogle Scholar
  • 29 Davidian M M, Powell A, Benenati J F, Katzen B T, Becker G J, Zemel G. Initial results of reteplase in the treatment of acute lower extremity arterial occlusions.  J Vasc Intervent Radiol . 2000;  11 289-294
    PubMedGoogle Scholar
  • 30 Califf R M. Combination therapy for acute myocardial infarction: fibrinolytic therapy and glycoprotein IIbIIIa inhibition.  Am Heart J . 2000;  139(2, Pt 2) S33-S37
    CrossrefPubMedGoogle Scholar
  • 31 Van de Werf F, Cannon C P, Luyten A. Safety assessment of single-bolus administration of TNK tissue plasminogen activator in acute myocardial infarction: the ASSENT-1 trial. The ASSENT Investigators.  Am Heart J . 1999;  137 786-791
    PubMedGoogle Scholar
  • 32 Gibson C M, Cannon C P, Murphy S A. Weight-adjusted dosing of TNK-tissue plasminogen activator and its relation to angiographic outcomes in the thrombolysis in myocardial infarction 10B trial. TIMI 10B Investigators.  Am J Cardiol . 1999;  84 976-980
    CrossrefPubMedGoogle Scholar
  • 33 Cragg A H. Lower extremity deep venous thrombosis: a new approach to obtaining access.  J Vasc Intervent Radiol . 1996;  7 283-288
    PubMedGoogle Scholar
  • 34 Armon M P, Whitaker S C, Tennant W G. Catheter-directed thrombolysis of iliofemoral deep vein thrombosis. A new approach via the posterior tibial vein.  Eur J Vasc Endovasc Surg . 1997;  13 413-416
    PubMedGoogle Scholar
  • 35 O'Sullivan G, Semba C P, Bittner C A. Endovascular management of iliac vein (May-Thurner) syndrome.  J Vasc Intervent Radiol . 2000;  11 823-836
    PubMedGoogle Scholar
  • 36 Seidensticker D, Wilcox J, Gagne P. Treatment of May-Thurner syndrome with catheter-directed thrombolysis and stent placement complicated by heparin-induced thrombocytopenia.  Cardiovasc Surg . 1998;  6 607-613
    PubMedGoogle Scholar
  • 37 Binkert C A, Schoch E, Stuckmann G. Treatment of pelvic venous spur (May-Thurner syndrome) with self-expanding metallic endoprosthesis.  Cardiovasc Intervent Radiol . 1998;  21 22-26
    CrossrefPubMedGoogle Scholar
  • 38 Gurbel P A, O'Connor C M, Cummings C C, Serebruany V L. Clopidogrel: the future choice for preventing platelet activation during coronary stenting?.  Pharmacol Res . 1999;  40 107-111
    CrossrefPubMedGoogle Scholar
  • 39 Comerota A J, Aldridge S C, Cohen G. Catheter-directed thrombolysis for iliofemoral DVT improves health-related quality-of-life.  J Vasc Surg . 2000;  32 130-137
    CrossrefPubMedGoogle Scholar
  • 40 Virchow R. Uber die Erweiterung kleiner Gefasse.  Arch Pathol Anat . 1851;  3 427-429
    PubMedGoogle Scholar
  • 41 May R, Thurner J. The cause of the predominately sinistral occurrence of thrombosis of the pelvic veins.  Angiology . 1957;  8 419-427
    CrossrefPubMedGoogle Scholar
  • 42 Cockett F B, Thomas M L, Negus D. Iliac vein compression: its relation to iliofemoral thrombosis and the post-thrombotic syndrome.  BMJ . 1967;  2 14-19
    PubMedGoogle Scholar
  • 43 Gibbens D T, DePalma J, Albanese J, Castner D, Triolo J. Percutaneous thrombolysis of hemodialysis grafts using reteplase.  J Vasc Intervent Radiol . 2000;  11(2, Pt 2) 250(Abst)
    PubMedGoogle Scholar
  • 44 Wolf B A, Jaffe J W, Newcomb J A, Shaff D I. The safety and efficacy of reteplase for thrombolysis.  J Vasc Intervent Radiol . 2000;  11(2, Pt 2) 288(Abst)
    PubMedGoogle Scholar
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