NARRATIVE:Clot formation in deep veins (deep vein thrombosis [DVT]), such as large veins in the lower extremities and pelvis, is common with an annual incidence approximating 900,000 in the United States.1,2 Some patients with DVT (20%-50%) develop long-term complications such as postthrombotic syndrome (PTS).1-3 PTS is manifested by signs and symptoms including swelling of the affected limb, pain, cramps, burning or prickling sensations (paresthesias), itching, redness, skin color change, and varicose vein formation.4 The severe form of PTS can cause skin ulcers from venous stasis.4 These chronic symptoms can reduce patient mobility, affect quality of life, and increase health care costs, particularly with moderate and severe disease. The severity of PTS is determined by grading systems such as the Villalta score.1-3,5 This scoring system is composed of signs and symptoms of PTS, with scores of 5-9 defined as mild and scores of ≥10 defined as moderate to severe.5 Drugs that prevent clot formation (anticoagulants) can treat DVT but do not prevent PTS in all patients, and residual clots and venous valvular incompetence due to the dilatation of the veins can increase the risk of PTS and recurrent VTE.6-9 Dissolving the existing clot (thrombolysis) may reduce the risk of PTS but may also increase the risk of bleeding complica-tions.10 To reduce the risk of bleeding, a clot-dissolving medication can be applied directly next to the clot, a strategy called catheter-directed thrombolysis (CDT).11,12
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