Endovascular Local Thrombolytic Therapy of Ileofemoral and Inferior Caval Vein Thrombosis

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Abstract
The intrathrombus delivery of thrombolytic agent to patients with deep vein thrombosis extending above the groin was introduced in the early 1990s as an alternative to systemic thrombolysis. The technique requires proper positioning of an indwelling catheter with its tip into the thrombus. Up to now urokinase as well as alteplase have been used in different dosage schemes. Repeated injection of contrast fluid monitors progress of treatment. Rapid lysis with restoration of patency is achieved in roughly three of four patients treated, usually with prompt clinical improvement. Underlying stenotic lesions are frequently relieved by insertion of metallic stents. Data on long term patency are still scarce, and no comparative trials with conventional anticoagulation are available. Bleeding is the most feared complication, and a few serious bleeding incidents have been reported. Local thrombolysis appears an interesting but labor-intensive approach in expert hands, but a definite place in management of venous thrombosis remains to be established.

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