Two therapeutic approaches for acute iliofemoral venous thrombosis: a comparative study

Objective: To compare the clinical effectiveness between percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis and simple thrombolysis via dorsal vein of foot in treating acute iliofemoral venous thrombosis. Methods: Seventy-eight patients with acute iliofemoral venous thrombosis, which was confirmed by venography, were enrolled in this study. The inferior vena cava filter was initially placed in all patients. Based on the therapeutic method, the patients were divided into two groups. Patients in group A (n=33) received simple thrombolysis via dorsal vein of foot, while patients in group B (n=45) received percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis. Urokinase was used in the patients of group A. Percutaneous mechanical thrombectomy and catheter-directed thrombolysis were employed in the patients of group B. The overall therapeutic effectiveness, the detumescence rate of the diseased lower limb, the treatment time and the incidence of complications were documented. The results were compared between the two groups. Results: The total effective rates of group A and group B were 87.9% and 100% respectively (P<0.05). The detumescence rates of the diseased thigh of group A and group B were (52.9±23.6)% and (65.1±14.2)% respectively (P<0.05). And the detumescence rates of the diseased leg of group a and group B were (66.0±21.4)% and (72.5±10.6)% respectively (P<0.05). The treatment time in group A was longer than that in group B. Both of the dose of urokinase used in the procedure and the incidence of complications in group A were higher than those in group B. The interior vena cava filter was retrieved in 15 cases in group A 34 cases in group B. All the patients were followed up for half a year. The iliofemoral venous thrombosis reappeared in 6 patients of group A, while no relapse was observed in the patients of group B. Conclusion: For the treatment of acute iliofemoral venous thrombosis, percutaneous mechanical thrombectomy thrombectomy combined with catheter-directed thrombolysis is more effective than simple thrombolysis via dorsal vein of foot, and, moreover, it carries fewer complications. (authors)