Catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis.

Patients with acute iliofemoral deep venous thrombosis often experience severe postthrombotic complications that result from venous obstruction and valve incompetence. Conventional anticoagulation prevents thrombus extension, fatal pulmonary embolism, and recurrence of the deep venous thrombosis, but it can hardly minimize the postthrombotic complications. Whether early thrombus removal significantly reduces the postthrombotic morbidity is an important question related to the treatment of these patients. This article will chiefly introduce rationale for and evidence supporting early thrombus removal for acute iliofemoral deep venous thrombosis, and the development and current status of catheter-directed thrombolysis and adjunctive percutaneous mechanical thrombectomy or pharmacomechanical thrombolysis, which are usually the first line of therapy for early removal of an acute thrombus in the proximal veins of the leg. In addition, we will briefly introduce the development of new pharmacologic agents.