Comparison of the efficacy and safety of catheter-directed thrombolysis using different approaches in the treatment of deep venous thrombosis of the lower limbs

Background The optimal catheter-directed thrombolysis approach for lower-extremity deep vein thrombosis (DVT) remains controversial. We aimed to compare the efficacy and safety of antegrade and retrograde catheter-directed thrombolysis in treating lower-extremity DVT. Methods This retrospective study included 140 consecutive patients with lower-extremity DVT who underwent catheter-directed thrombolysis at our hospital from January 2020 to December 2023. Patients were divided into 2 groups by access route: antegrade (n = 75, including 47 with infrapopliteal access) and retrograde (n = 65). Propensity score matching balanced the baseline characteristics and minimized selection bias. Thrombolytic effect, limb swelling rate, venous patency, and complications for each approach were evaluated. Results After propensity score matching, comparative analysis revealed significantly higher thigh and calf circumference reduction rates in the antegrade group than in the retrograde group (3.66% vs. 2.06%, p = 0.012). However, no significant differences were observed between the groups regarding thrombolytic effect, postoperative Porter score, patency rate, or complications. Subgroup analysis showed that the infrapopliteal vein approach was associated with a greater reduction in calf swelling and improved venous patency. Conclusions Antegrade catheter-directed thrombolysis may help reduce postoperative limb swelling. Infrapopliteal venous puncture can also decrease calf swelling and improve venous patency. These findings suggest that procedural modifications could optimize catheter-directed thrombolysis outcomes; however, larger studies are required to validate these observations.