Local injection of tissue-plasminogen activator using a pulse spray catheter as a treatment option for proximal deep vein thrombosis: A case report

A 24-year-old woman was admitted to our hospital with the diagnosis of pulmonary thromboembolism (PTE) and left common iliac vein thrombosis. She had used low-dose contraceptive pill for dysmenorrhea. Otherwise, her laboratory data did not show any other thrombotic risk factors. Thrombus in the common iliac vein usually requires a permanent inferior vena cava (IVC) filter. However, the use of long-term warfarin should have been avoided for her potential future pregnancy. A retrievable IVC filter was placed and catheter directed thrombolysis was performed for her deep vein thrombosis (DVT). Local injection of monteplase from a pulse spray catheter was performed for 4 days. After the catheter-based treatment, the thrombus resolved and the IVC filter was successfully removed on day 19. The patient was discharged on day 21. Warfarin therapy was discontinued 6 months after discharge.