In Reply to: Re: Case 0298_03 --Reconstruction of a chronically occluded iliac vein posted by Moni Stein on February 04, 1998 at 15:13:29:
I agree Moni. We are learning that urokinase has little effect after 14 to 21 days duration of symptoms. One problem in general is that, as opposed to arterial thrombosis, patients can rarely give an accurate history of their onset of symptoms. As you know, venous occlusion is very subtle at times - "for the past couple of weeks my leg has been feelin' funny". Thus it is difficult to know exactly how old the DVT is. Most investigators probably still rely on the history combined with the "guidewire" test. If the clot is relatively soft, then try UK. But if it takes some muscle to get the wire through, then defer to PTA and stents.
P.S. I hope you're not flooded out in Sacramento!