To investigate the efficacy and disadvantages of retrograde catheter-directed thrombolysis in the treatment of deep venous thrombosis (DVT).

A total of 213 patients with acute lower extremity DVT from January 2010 to December 2017 were retrospective analysed, including retrograde catheter-directed thrombolysis (CDT) group (n=150) and anticoagulation alone group (n=63). Thrombus clearance rate, iliofemoral vein patency at 6 months, post-thrombotic syndrome (PTS) at 12 months, venous valvular regurgitation and quality of life scores were compared between the two groups.

In CDT group, the clearance rate of iliac vein thrombosis was significantly better than that of anticoagulation alone (P=0.011), but there was no difference in the clearance rate of femoral and popliteal vein thrombosis (P>0.05). The effect of retrograde CDT on common femoral vein thrombosis was better in iliofemoral DVT than that in popliteal to iliac DVT. Accordingly, the patency rate of iliac vein at 6 months in CDT group was higher than that in anticoagulation group (P=0.002), but there was no difference in patency rate of femoral vein between the two groups. The incidence of PTS and severe PTS in the CDT group was lower than that in the anticoagulation group (P<0.0 001), but there was no significant difference in the incidence of mild to moderate PTS between the two groups (P>0.0 001). The venous valvular regurgitation in the CDT group was similar to that in the anticoagulation group at 12 months, but the quality of life in the CDT group was higher than that in the anticoagulation group (P<0.0 001).

Retrograde CDT has a certain advantage for iliac venous thrombosis. However, due to the difficulty of catheterization, venous valve injury and other reasons, if there is no special situation, retrograde CDT is recommended as the second choice for thrombosis involving the femoral and popliteal vein.