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Objective: Post-thrombotic syndrome is a potential complication of iliofemoral deep venous thrombosis. Successful thrombus resolution with catheter-directed thrombolysis reduces the morbidity associated with this condition. Ultrasound-enhanced catheter-directed thrombolysis may favorably augment clot lysis compared to conventional catheter-directed thrombolysis.

Methods: Between January 2009 and July 2011, 29 cases of ultrasound-enhanced catheter-directed thrombolysis were performed for the treatment of iliofemoral deep venous thrombosis. Thrombolysis was assessed to be technically successful if there was >50% clot resolution (complete lysis >90% and partial lysis 50-90%).

Results: Nine patients reported a prior history of ipsilateral deep venous thrombosis. The mean time from onset of symptoms to intervention was 18.9 days (range 1-90 days). The mean tPA dose delivered was 19.7 mg and the mean duration of therapy was 30.1 hours. At the completion of thrombolytic therapy, clot lysis was successfully obtained in 22/29 (76%) of patients (complete 15/29; 52%, and partial 7/29; 24%). Additional venous interventions (percutaneous mechanical thrombectomy, angioplasty, and/or stent placement) to treat persistent venous stenosis or occlusion were performed in 83% (24/29). No patient experienced new pulmonary emboli, early rethrombosis, or bleeding complications during treatment. Three patients required either reduction or cessation of thrombolytic therapy secondary to acute decreases in serum fibrinogen (<150 mg/dL). The majority of patients (90%; 26/29) experienced clinical improvement in their lower extremity symptoms immediately following treatment.

Conclusions: Ultrasound-enhanced catheter-directed thrombolysis is safe and effective form of therapy for the treatment of iliofemoral deep venous thrombosis.