Comparative outcomes of catheter-directed thrombolysis versus AngioJet pharmacomechanical catheter-directed thrombolysis for treatment of acute iliofemoral deep vein thrombosis

Exploring the efficacy of recombinant human pro-urokinase in catheter-directed thrombolysis for acute lower extremity deep venous thrombosis patients

BACKGROUND

Effective and innovative treatment for patients with acute lower-extremity deep venous thrombosis (DVT) is lacking. This study explored the use of recombinant human pro-urokinase (rhPro-UK) in catheter-directed thrombolysis for acute DVT patients.

METHODS

A retrospective analysis included 85 acute DVT patients undergoing CDT from January 2021 to December 2023. Patients were divided into an observation group (n = 43, rhPro-UK) and a control group (n = 42, UK). Outcomes assessed included total effective rate, venous patency score, limb circumference differences, coagulation parameters (PT, APTT, Fg), adverse events (BARC criteria), and post-thrombotic syndrome (PTS) incidence at 6 months (Villalta scale).

RESULTS

The observation group treated with rhPro-UK demonstrated superior clinical outcomes compared to the control group receiving urokinase. The total effective rate was significantly higher in the rhPro-UK group (P = 0.011), with improved venous patency reflected by a lower post-treatment patency score (P = 0.009) and higher patency rate (80.86% vs. 72.86%, P = 0.045). Limb swelling reduction was more pronounced in the rhPro-UK group, evidenced by smaller thigh (P = 0.002) and calf circumference differences (P = 0.001). Coagulation function improved significantly, with prolonged PT (P = 0.002) and APTT (P = 0.001), alongside reduced fibrinogen levels (P < 0.001). Safety outcomes favored rhPro-UK, with fewer total bleeding events (14.29% vs. 4.65%, P = 0.039) and no major bleeding (BARC Type 3) observed. At 6-month follow-up, the rhPro-UK group exhibited a markedly lower incidence of post-thrombotic syndrome (9.3% vs. 26.2%, P = 0.034) and sustained venous patency, confirming its long-term efficacy.

CONCLUSION

CDT with rhPro-UK significantly improves venous patency, reduces limb swelling, optimizes coagulation function, and minimizes complications compared to UK. Its fibrin-targeted mechanism enhances clinical efficacy and safety, supporting its adoption as a superior thrombolytic for acute DVT.

TRIAL REGISTRATION

Not applicable.

Acute and Chronic Ilio-Femoral Venous Reconstruction

Ilio-femoral venous reconstruction has progressed from being only performed by a limited number of pioneers (often using equipment repurposed from other areas of interventional radiology) to a discrete subspecialty of endovascular practice with a dedicated range of tools and increasingly evolved techniques to secure optimal results. This review is intended to reflect the modern practice of ilio-femoral stenting in the acute and chronic settings, from initial patient assessment to completion of procedure and follow-up care.

Pharmacomechanical Thrombectomy and Catheter-Directed Thrombolysis, with or without Iliac Vein Stenting, in the Treatment of Acute Iliofemoral Deep Vein Thrombosis

BACKGROUND

This study aims to evaluate and compare the outcomes and clinical efficacy of pharmacomechanical thrombectomy (PMCT) plus catheter-directed thrombolysis (CDT) and PMCT combined with CDT and venous stenting in managing acute iliofemoral deep vein thrombosis (DVT), while also assessing the long-term safety and efficacy of these interventions.

METHODS

A retrospective case-control study spanning 3 years involved 112 patients presenting with acute symptomatic iliofemoral deep vein thrombosis (DVT), each with a symptom duration of less than 14 days. Patients were consecutively categorized into two groups based on individual clinical indications: PMCT + CDT vs. PMCT + CDT + venous stent. Statistical analyses were conducted to compare clinical features and outcomes between the two groups. Additionally, patients were followed up for 24 months post-treatment, during which quality of life (QoL) and severity of post-thrombotic syndrome (PTS) were analyzed.

RESULTS

In this retrospective study, we analyzed a total of 112 consecutive patients, with 63 patients undergoing PMCT + CDT and 49 patients undergoing PMCT + CDT + venous stent. Between the two groups, regarding primary outcomes at 6 months, there was no difference in the observed cumulative patency rates, standing at 82.5% for PMCT + CDT and 81.6% for PMCT + CDT + stent. Survival analyses for primary, primary-assisted, and secondary patency yielded comparable results for PMCT + CDT, with p-values of 0.74, 0.58, and 0.72, respectively. The two-year patency rate was high in both groups (85.7% for PMCT + CDT vs. 83.7% for PMCT + CDT + stent). Additionally, during the follow-up period, there were no statistically significant differences observed in the incidence of PTS or the average Villalta score between the two groups. At 24 months post-intervention, the incidence of post-thrombotic syndrome (PTS) was 11.1% in the PMCT + CDT group and 22% in the PMCT + CDT + stent group (p = 0.381). Both treatment arms of the study groups experienced bleeding complications during the thrombolysis therapy; in the PMCT + CDT group, there were three cases of gastrointestinal bleeding, compared to two cases in the PMCT + CDT + stent group (p = 0.900). Additionally, there was one intracranial hemorrhage in the PMCT + CDT group and two in the PMCT + CDT + stent group.

CONCLUSIONS

Pharmacomechanical thrombectomy (PMCT) combined with catheter-directed thrombolysis (CDT) therapy has shown significant efficacy in alleviating leg symptoms and reducing the occurrence of post-thrombotic syndrome (PTS), including the incidence of moderate-to-severe PTS. On the other hand, the utilization of PMCT + CDT + stent therapy, tailored to individual patients' clinical and venous conditions, may enhance long-term venous patency and lead to superior outcomes, including improved quality of life parameters.

The emerging role of mechanical thrombectomy in acute DVT management

Catheter directed thrombolysis (CDT) and pharmacomechanical thrombectomy in various technical combinations have been the main driver of acute deep venous interventions for over a decade. While the majority of high-level evidence was based on it, CDT requires longer procedural care and is associated to a small but not negligible bleeding risk. Contemporary DVT intervention, following the paradigm shift in myocardial infarction and stroke management, has steadily migrated towards minimizing or eliminating thrombolytics due to the introduction of mechanical/aspiration thrombectomy. Mechanical thrombectomy (MT) devices are undoubtedly improving our ability to remove thrombus more efficiently in a single session without the adverse events and complex logistics related to the use of thrombolytics.