Background: To compare the clinical efficacy and safety of catheter-directed thrombolysis (CDT) using the anterior tibial vein approach (ATVA) and popliteal vein approach (PVA) for acute lower-extremity deep venous thrombosis (LEDVT).
Methods: From March 2014 to October 2015, 63 patients with unilateral acute extensive LEDVT were enrolled in this study: 36 patients received CDT via the PVA group, and 27 patients received CDT via the ATVA group. Limb circumference, thrombus score, complications, thrombolytic time, and the amount of thrombolytic agents administered were recorded. Postthrombotic syndrome (PTS) and venous insufficiency were assessed at 1 year after treatment.
Results: Thrombus scores were significantly decreased in both groups after CDT therapy (each P < 0.001). There was no significant difference in the detumescence and thrombolytic rates, thrombolytic times and administered amounts of thrombolytic agents between the 2 groups (each P > 0.050). The limb circumference difference below the knee in the ATVA group was lower than that in the PVA group (P = 0.029), and the ATVA resulted in fewer complications, especially sheath bleeding (P = 0.025). At the 1-year follow-up, popliteal venous insufficiency was present in 36.11% of the PVA group and 25.93% of the ATVA group (P = 0.390). In addition, PTS was observed in 13.89% of the PVA group compared with 7.41% of the ATVA group (P = 0.268).
Conclusions: CDT is an effective and safe method for treating acute LEDVT. The ATVA is an effective and feasible approach for CDT with a lower incidence of complications than the PVA.
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