To evaluate the safety and efficacy of transarterial followed by transvenous catheter directed thrombolysis for acute treating mixed-type lower extremity deep vein thrombosis (LEDVT).

Clinical data of 26 patients with acute mixed-type LEDVT were retrospectively analyzed. All patients were performed insertion of inferior vena cava filter before operation. The left brachial artery was punctured to place thrombolysis catheter into the affected side iliac artery. After 2-3 days, angiography review was evaluated, and the affected popliteal vein was punctured to give percutaneous intraluminal angioplasty & percutaneous mechanical thrombectomy & catheter directed thrombolysis (PTA&PMT&CDT). The thrombus clearance, the decrease of the circumference of the affected lower extremity and complications were observed.

After transarterial thrombolysis, 24 cases (92.31%) had the thrombosis dissolved in the popliteal vein and the veins below the knee. The PTA+PMT+CDT treatment was performed once in 17 cases (65.39%), 2 times in 7 cases (26.92%) and 3 times in 2 cases (7.69%) followed by iliac vein stents placement. The thrombus clearance rate was grade Ⅲ in 22 cases (84.62%), grade Ⅱ in 2 cases (7.69%), and grade I in 2 cases (7.69%). Before treatment, the difference of the upper knee circumference between the affected side and the healthy side was (5.02±2.29) cm, and after treatment the difference was (0.74±0.18) cm, and there was a statistically significant difference (t=7.601, P<0.001). There were no serious complications during thrombolysis.

For acute mixed-type LEDVT, transarterial CDT via iliac artery followed by popliteal vein PTA+PMT+CDT is safe and effective.