State of the art of catheter-directed thrombolysis for iliofemoral venous thrombosis

This review is aimed at presenting basic knowledge on catheter-directed thrombolysis (CDT), including stenting and other additional procedures, but without going too far into the fine technical details. The most important published evidence on CDT has been presented, even if many questions associated with this issue still remain unanswered. CDT for iliofemoral venous thrombosis has been known for 25 years. CDT has developed after not very successful attempts to manage iliofemoral thrombosis with systemic or regional thrombolysis, which was associated with mortalities, severe bleedings, and poor recanalisation rates. Administration of a lytic agent directly into the thrombus allows high local concentration of an active substance and minimises systemic action of the drug. Clinical experience has shown that it is obvious that in a case of deep vein thrombosis all occluded veins should be recanalised, with special focus at iliofemoral veins, since the majority of cases of severe post-thrombotic syndrome are associated with poorly recanalised iliac veins. It is also important to implant a stent in the case of residual obstruction of the iliac vein at the same session. A number of factors play a role in successful final outcome, and published guidelines may influence decision making. In order to facilitate sharing the knowledge in this field, it is recommended to use internationally accepted definitions and terms.