Stepwise cannulation of the small saphenous vein for thrombolysis: A technique to optimize clot removal and reduce the severity of post-thrombotic syndrome.

Abstract

A retrospective analysis was conducted on the clinical data of 50 patients with acute mixed-type lower extremity deep vein thrombosis treated at the Affiliated People's Hospital of Ningbo University. All patients underwent catheter-directed thrombolysis via small saphenous vein access. The thrombolytic catheter was inserted into the deep venous thrombus through either infrapopliteal deep veins or the popliteal vein. Continuous infusion of urokinase via a microinfusion pump was administered at a dose of (178.32 ± 79.45) × 10⁴ U for direct clot dissolution. The efficacy was evaluated by comparing the pre-operative and post-operative circumferences of the upper and lower knees, venous patency scores, and thrombolysis rates. Post-operatively, all patients in the group showed significant improvement in symptoms after thrombolysis. Among the 50 patients who were treated, the pre-operative versus post-operative reduction in suprapatellar circumference difference was 74% ± 6% and the pre-operative versus post-operative reduction in infrapatellar circumference difference was 78% ± 6%. The venous patency score significantly improved (P < 0.01), with a thrombolysis rate of 78% ± 6%. No serious complications occurred during the treatment process. This study shows that direct thrombolysis through the saphenous vein catheter for acute mixed-type lower limb deep vein thrombosis is a safe, effective, and feasible treatment method.