Using imaging guidance, CDT involves delivery of a pharmacologic thrombolytic agent directly into the venous thrombus through an infusion catheter and/or wire embedded within the thrombosed vein. Based on available evidence, adjunctive CDT plus anticoagulant therapy is acceptable for initial treatment in many patients with acute iliofemoral DVT. The rationale for this strategy includes the following:

Anticoagulant therapy alone does not prevent PTS in a significant proportion of patients with acute proximal DVT. The symptoms of PTS, including chronic limb edema, heaviness, pain, venous claudication limiting activities, stasis dermatitis, and venous ulcerations in advanced cases cause significant disability, quality of life impairment, and socioeconomic costs. Anticoagulant therapy protects against PTS only to a limited degree by preventing recurrent ipsilateral DVT, a major risk factor for PTS. Long-term compression therapy may further reduce risk but is highly inconvenient.

Patients with iliofemoral DVT are considered at significantly increased risk for PTS and for late disability. The natural history of iliofemoral DVT is different from that of isolated femoropopliteal DVT, in which endogenous recanalization of the femoropopliteal venous segment and development of collateral vessels often increase venous outflow and limit PTS severity. In contrast, a thrombosed iliac vein rarely recanalizes spontaneously, and persistent venous outflow obstruction often causes major increases in ambulatory venous pressures. Patients with iliofemoral DVT therefore have high rates of PTS-related disability.

Treatment strategies for early thrombus removal may prevent PTS by eliminating venous obstruction, preserving valvular function, and maintaining late venous patency.

In addition to its significant potential to prevent PTS, CDT has distinct advantages over surgical venous thrombectomy, systemic thrombolysis, and anticoagulation alone. For acute iliofemoral DVT, adjunctive CDT has success rates of approximately 90%. Unlike surgical thrombectomy, CDT does not require general anesthesia, a surgical incision, or prolonged recovery.

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