Skip to main content

Advertisement

SpringerLink
Log in

The perplexity of catheter-directed thrombolysis for deep venous thrombosis: the approaches play an important role

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

A Correction to this article was published on 25 September 2020

This article has been updated

Abstract

The recent adjunctive catheter-directed thrombolysis (ATTRACT) trial rose a controversy about the treatment effect of catheter-directed thrombolysis (CDT) in deep venous thrombosis (DVT). In fact, most studies including the ATTRACT trial did not perform subgroup analysis of catheterization approaches. Different approaches would confound the conclusions. Therefore, a single-center retrospective analysis was performed to compare the differences between the antegrade (AGA) and retrograde (RGA) approaches. Total 217 DVT patients treated with CDT were enrolled from January 2010 to December 2017, with mean age of 55.3 years (67 received antegrade approach, 150 received retrograde approach). The clot burden reduction by segment was evaluated. The mean access establishment time and thrombolytic time were compared. The patency of the iliofemoral vein at 6 months was evaluated. The rate of PTS, quality of life and venous insufficiency were assessed at 1 year. AGA group showed better thrombolytic effect in popliteal and femoral vein than RGA group. The rate of iliofemoral clot burden reduction in RGA group was mostly at Grade II, while most were at Grade III in AGA group. The retrograde approach showed better thrombolysis effect in iliofemoral DVT than popliteal to iliac DVT. The RGA group reported longer mean access establishment time (5.4 ± 1.8 vs 27.0 ± 7.5 min, p < 0.001) and thrombolytic time (6.9 ± 1.5 days vs 6.8 ± 1.5 days, p = 0.586). At 6 months, RGA group had a lower rate of femoral vein patency (52.0% vs 89.6%, p < 0.001) and a higher rate of venous insufficiency (52.0% vs 29.9%, p < 0.001), compared with AGA group. Although there was no difference in the rate of PTS, the RGA group showed higher Villalta scores in the free and mild PTS. The antegrade approach was preferably recommended over the retrograde approach for CDT treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Change history

References

  1. Yadam S, Sharara R, Naddour M et al (2017) Advanced therapies in venous thromboembolism. Crit Care Nurs Q 40:251–259

    Article  Google Scholar 

  2. Kearon C, Akl EA, Comerota AJ et al (2012) Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:419–496

    Article  Google Scholar 

  3. Kahn SR, Shbaklo H, Lamping DL et al (2008) Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost 6:1105–1112

    Article  CAS  Google Scholar 

  4. Watson LI, Armon MP (2004) Thrombolysis for acute deep vein thrombosis. Cochrane database Syst Rev. https://doi.org/10.1002/14651858.CD002783.pub3

    Article  PubMed  Google Scholar 

  5. Enden T, Haig Y, Kløw NE et al (2012) Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet 379:31–38

    Article  Google Scholar 

  6. Vedantham S, Goldhaber SZ, Julian JA et al (2017) Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med 377:2240–2252

    Article  Google Scholar 

  7. Pianta MJ, Thomson KR (2011) Catheter-directed thrombolysis of lower limb thrombosis. Cardiovasc Intervent Radiol 34:25–36

    Article  Google Scholar 

  8. Jaffe JW, Newcomb JA, York T, Matulewicz TJ (1996) Venous valvular assessment after retrograde catheterization. J Vasc Interv Radiol 7:595–597

    Article  CAS  Google Scholar 

  9. Ming ZB, Li WD, Yuan RF et al (2017) Effectiveness of catheter directed thrombolysis and stent implantation on iliofemoral vein thrombosis caused by iliac vein compression. J Thromb Thrombolysis 44:254–260

    Article  Google Scholar 

  10. Kearon C, Akl EA, Ornelas J et al (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149:315–352

    Article  Google Scholar 

  11. Park YJ, Choi JY, Min SK et al (2008) Restoration of patency in iliofemoral deep vein thrombosis with catheter-directed thrombolysis does not always prevent post-thrombotic damage. Eur J Vasc Endovasc Surg 36:725–730

    Article  CAS  Google Scholar 

  12. Wang H, Qi X, Chen Y, Sun J (2018) A retrospective study comparing 2 approaches to catheter-directed thrombolysis for acute deep venous thrombosis. Ann Vasc Surg 50:30–37

    Article  Google Scholar 

  13. Kahn SR, Partsch H, Vedantham S et al (2009) Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization. J Thromb Haemost 7:879–883

    Article  CAS  Google Scholar 

  14. Kahn SR, Desmarais S, Ducruet T et al (2006) Comparison of the Villalta and Ginsberg clinical scales to diagnose the post-thrombotic syndrome: correlation with patient-reported disease burden and venous valvular reflux. J Thromb Haemost 4:907–908

    Article  CAS  Google Scholar 

  15. Baheti A, Sheeran D, Patrie J et al (2019) Suprarenal inferior vena cava filter placement and retrieval: safety analysis. J Vasc Interv Radiol. https://doi.org/10.1016/j.jvir.2019.08.012

    Article  PubMed  Google Scholar 

  16. Wang CN, Deng HR (2018) Percutaneous endovenous intervention plus anticoagulation versus anticoagulation alone for treating patients with proximal deep vein thrombosis: a meta-analysis and systematic review. Ann Vasc Surg 49:39–48

    Article  Google Scholar 

  17. Fleck D, Albadawi H, Shamoun F et al (2017) Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations. Cardiovasc Diagn Ther 7:S228–S237

    Article  Google Scholar 

  18. Kahn SR, Julian JA, Kearon C et al (2020) Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep venous thrombosis. J Vasc surgery Venous Lymphat Disord 8:8–23.e18

    Article  Google Scholar 

  19. Rottenstreich A, Kalish Y, Elchalal U et al (2019) Retrievable inferior vena cava filter utilization in obstetric patients. J Matern Neonatal Med 32:3045–3053

    Article  Google Scholar 

  20. Huegel U, Surbek D, Mosimann B, Kucher N (2019) Radiation- and contrast medium-free catheter-directed thrombolysis for early pregnancy-related massive iliocaval deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 7:122–125

    Article  Google Scholar 

  21. Lim CS, Waseem S, El-Sayed T et al (2020) Patient radiation exposure for endovascular deep venous interventions. J Vasc Surg Venous Lymphat Disord 8:259–267

    Article  Google Scholar 

  22. Park EA, Chung JW, Lee W et al (2011) Three-dimensional evaluation of the anatomic variations of the femoral vein and popliteal vein in relation to the accompanying artery by using CT venography. Korean J Radiol 12:327–340

    Article  Google Scholar 

  23. Chen G, Shi W, He X et al (2017) Feasibility of continuous, catheter directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding. Exp Ther Med 13:751–758

    Article  CAS  Google Scholar 

Download references

Acknowledgements

As the first author, Dr. Qian thanks his wife Yezhou Hu, for her moral support and love, and he expects to spend his rest life with her.

Funding

There was no outside funding for this study.

Author information

Authors and Affiliations

  1. Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, P.R. China

    Chengheng Qian, Guo-ping Chen, Wen-sheng Lou, Tao Wang & Ying-hao Li

Authors
  1. Chengheng Qian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guo-ping Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wen-sheng Lou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tao Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ying-hao Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors have had access to the data and participated in study design, data collection and manuscript preparation. This manuscript is not in submission to any other journal.

Corresponding author

Correspondence to Guo-ping Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qian, C., Chen, Gp., Lou, Ws. et al. The perplexity of catheter-directed thrombolysis for deep venous thrombosis: the approaches play an important role. J Thromb Thrombolysis 51, 757–766 (2021). https://doi.org/10.1007/s11239-020-02222-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-020-02222-4

Keywords

Search

Navigation