| Objective: To evaluate the clinical effectiveness of catheterization via the greatsaphenous vein in catheter-directed intrathrombus thrombolysis for acuteiliofemoral deep vein thrombosis.Methods: Our prospective study included 73 patients with documented acuteiliofemoral deep vein thrombosis. Exclusion criteria included contraindications tothe use of anticoagulation, contrast media, or thrombolytic agents, such as activeinternal bleeding, acute cerebrovascular accident, recent major surgery, recentserious trauma, severe hypertension, pregnancy, bacterial endocarditis, possibilityof intracardiac thrombus.73 patients were divided into three groups. In group 1(the great saphenousvein group) the patients received catheter-directed thrombolytic therapy, whichrelies on administration of thrombolytic agents directly into the clot with use of avariety of infusion catheters or wires and the venous access site was used theipsilateral great saphenous vein. In group 2 (the foot vein group) the patientsreceived flow-directed regional thrombolytic therapy, which is based on directregional high-concentration infusion of the thrombolytic agent from an ipsilateraldorsal foot vein into the deep venous system. This approach is based on the abilityto redirect most of the flow from the dorsal vein cannula into the deep venoussystem by the use of a series of properly tourniquet maintained during the entireinfusion duration. In group 3 (the great popliteal vein group) the patients received catheter-directed thrombolytic therapy via the ipsilateral popliteal vein. Patients inall groups received urokinase 250,000～750,000IU once a day through the dorsalfoot vein (the foot vein group) or the indwelling catheter(the great saphenous veingroup and the great popliteal vein group), LMW heparin 4100U subcutaneouslytwice daily and oral therapy with aspirin 0.1g once daily. Laboratory parametersincluded prothrombin time, activated partial thromboplastin time, and internationalnormalized ratio determined before and after lysis also were recorded during thepatient's hospital course.Thrombolysis should be stopped as follows:(1) Swelling and pain in affected extremity was effacement;(2) Serious complications happened;(3) There was no effect or the thrombosis had no change in venography 3days after therapy.Patients required endovascular balloon dilation and stent placement in theiliofemoral vein because of residual narrowing of greater than 30% luminaldiameter after CDT.Clinical efficacy grade was evaluated by measured the circumferencebetween normal and affected limbs before and after treatment. The venouspatency score and the rate of patency improvement were observed and calculatedbased on venographic results. The clinical results including the mean puncturationduration and complications of therapy were compared between the greatsaphenous vein group and the great popliteal vein group.Statistical analysis was performed with use of SPSS software (version 13.0;SPSS). Continuous variables are reported as means±SD. Comparisons wereperformed with use of the Student t test. The x2 test for comparison of proportionsof categoric variables was used to test statistical significance. A P value of less than.05 was used as a threshold for statistical significance.Results: In three groups, the total effective rate were the great saphenous veingroup 95.24%, the foot vein group 66.67% and the great popliteal vein group 96%.The comparison between the great saphenous vein group and the great poplitealvein group has no difference (95.24% vs 96%,P=0.549). The comparisonbetween the great saphenous vein group and the foot vein group show astatistically significant difference(95.24% vs 66.67%,P=0.039). The limbsedema reduction rate of the great saphenous vein group was significantly higherwhen compared with the foot vein group: (86.64±20.00)% vs. (68.54±22.87)%,P=0.002.The rate of the popliteal vein group was similar to the great saphenousvein group (85.69±14.62% vs 86.64±20.00%,P=0.868). Likewise, the rate ofvenous patency improvement in the great saphenous vein group and the greatpopliteal vein group were significantly higher than in the foot vein group(57.93±19.39% and 57.68±19.26% vs. 42.74±22.32%,P＜0.05).In contrast with the popliteal vein group, the mean puncturation duration ofthe great saphenous vein group was remarkable less (7.29±3.05 minutes vs..16.72±3.61 minutes, P＜0.05). It suggest that catheterization via the greatsaphenous vein may be easier than via the popliteal vein .In the great saphenousvein group, only 1 case occurred superficial phlebitis. However, there were 9case of hematoma and inflammation at venous entry site of the catheter deliverysystem in the popliteal vein group. The incidence of complications at the site ofinsertion in the great saphenous vein group was lower than that in the poplitealvein group (x2=4.84,P＜0.05). These findings indicated that catheterization viathe great saphenous vein is more convenient and safety.24 cases of PTA were performed and in 17 cases 26 stents were inserted,stenosis treatment with stents were more commonly found in left limbs (17 in left limbs and/in ngnt limbs). 46 inferior vena cava(IVC) filters were placed (1Antheor Temproal Filter, 10 recovery Opt EaseTM, 2 Greenfield Filter,12 SimonNitinol Filter, 17 Trap Ease Filter,2 Vena Tech-LGM Filter,2 Vena Tech-LP Filter).There were no serious complications such as pulmonary embolism in 73patients.Conclusions: Our clinical study and practice shows that the great saphenous veinis a new alternative access routes into the venous system. It is more safety andless complications for treatment of acute iliofemoral deep vein thrombosis withuse of catheter-directed intrathrombus thrombolysis.
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