Clinical Application of Catheter-directed Thrombolysis Combined with Primary Iliac Vein Stent Implantation in the Treatment of Iliac Vein Compression with Acute Lower Limb Deep Vein Thrombosis
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Abstract
Objective: Iliac vein compression syndrome (IVCS) with acute lower extremity deep vein thrombosis (DVT) is associated with significant morbidity, including chronic venous insufficiency and post-thrombotic syndrome. This study aims to evaluate the efficacy and safety of catheter-directed thrombolysis (CDT) combined with ZYLOX® Penguin venous stent implantation (first-stage) in treating IVCS-DVT.
Methods: We conducted a retrospective analysis of 56 patients with IVCS and acute lower extremity DVT who underwent CDT with concurrent iliac vein stenting at The Seventh People’s Hospital of Chongqing between June 2023 and March 2024. Clinical outcomes were assessed by measuring pre- and postoperative limb circumference differences, thrombus clearance rates, and rate of thrombosis in the right iliac vein and inferior vena cava. Follow-up evaluations at 1, 3, 6 and 12 months postoperatively included venous clinical severity score (VCSS) assessment and stent patency evaluation.
Results: The procedure achieved a technical success rate of 100%, with 98.2%.In 56 patients, the difference of circumferential diameter between the both side of lower limb (thigh and calf) decreased from preoperative (6.18 ± 0.91) cm and (3.98 ± 0.87) cm to postoperative (1.33 ± 0.64) cm and (1.21 ± 0.52) cm, respectively, with statistical significance (all p < 0.05). Primary patency was 12 months and significant symptom improvement as indicated by a reduction in Venous Clinical Severity Score (VCSS) from 9.9 ± 1.9 to 4.6 ± 1.3 (p < 0.05). Complications were minimal, including puncture-site bleeding (1.8%) and transient hematuria (8.9%), with no deaths or severe pulmonary embolism reported.
Conclusion: The application of CDT combined with first-stage iliac vein stent implantation for IVCS with acute lower limb DVT is safe and effective, and has a good clinical application prospect.
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