Selective thrombolytic therapy for deep venous thrombosis by using a small caliber catheter passed through a temporary vena cava filter

To evaluate the feasibility of selective thrombolytic therapy for deep venous thrombosis (DVT)by using a small caliber catheter passed through a temporary vena cava filter. During a 3-year period, 14 consecutive symptomatic patients (7 men, 7 women, age range, 35-80 years; mean, 62 years) were referred for treatment. Ten had acute DVT, and four were chronic. At first, a temporary filter catheter was introduced from the right subclavian vein, through which an infusion microcatheter(2.2F, 150 cm) was inserted. A pulse spray system (3F, 135 cm) was also employed. Urokinase (UK) was introduced locally into the thrombus by the pulse method (3,000 U/30 sec)and by continuous infusion (120,000-240,000 U/day). After complete clot dissolution, residual left common iliac vein narrowing in two patients (May-Thurner syndrome) was treated by means of PTA and placement of a Wallstent endoprosthesis. All patients continued to receive oral Warfarin. Dramatic improvement of symptoms was noted in all patients after treatment. Complete thrombolysis was achieved in 11 patients (11/14: 79% success rate). Each of three incomplete cases had chronic DVT. The duration of filter insertion was a mean 16 days (range, 8-37 days)after administration of a mean 2.58 million U of UK (range, 0.24-5.04 million U). No major or minor complications occurred. At present, no patients show recurrent symptoms. Selective thrombolytic therapy performed by using a small-caliber catheter passed through a temporary vena cava filter is safe and effective.