Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement

Background: While the predominant treatment of lower extremity deep venous thrombosis (DVT) remains systemic anticoagulation, there is a growing consensus that more aggressive percutaneous catheter directed thrombolysis (CDT) carries both short-term and long-term benefits. There remains controversy as to whether an inferior vena cava (IVC) filter is always required during CDT. Objective: To define the short- and long-term outcomes of CDT with and without prophylactic IVC filter placement for lower extremity DVT. Methods: A database of patients treated by CDT from 1996 to 2006 was compiled. Results were standardized to current Society for Vascular Surgery criteria. Average follow-up was 2.1 years, range of 1-8 years. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. Factor analyses were performed using a Cox proportional hazard model for time dependent variables. Data are presented as mean ± SD where appropriate. Results: Sixty-nine patients (39% male, average age 48 ± 17 years) underwent CDT: (27 received pharmacological thrombolysis, 12 received mechanical thrombolysis, and 30 received mechanical and pharmacological thrombolysis). Fourteen patients (20%) had IVC filter placement prior to or during CDT. Twenty-one had a hypercoagulable state. Technical success with grade III lysis of clot burden was achieved in 63%. Fifty-one patients required an adjuvant stent. Overall, 90-day all-cause mortality was 4% and peri-procedural morbidity was 4%. No patients developed a pulmonary embolus (PE) during therapy. By Kaplan-Meier analysis 83%, 83%, and 75% of patients were free of recurrent DVT at 1, 2, and 3 years, respectively. Hypercoagulability was associated with DVT recurrence by Cox proportional hazards analysis. No analyzed factor was predictive of PE. Conclusion: Catheter directed thrombolysis without universal prophylactic IVC filter placement is safe and effective in treating acute DVT. Pulmonary embolization did not occur during CDT. Selective rather than routine IVC filter placement is a safe and appropriate approach.