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Abstract Although anticoagulation is the current standard of care in management of DVT as it is effective in preventing clot propagation and pulmonary embolisation, it does not prevent long-term sequelae, specifically the development of postthrombotic syndrome. This condition is often severely disabling, may at times be limb threatening due to ulceration, and carries with it a high societal cost. A strategy of early clot removal is effective at preserving valve function and alleviating clinical symptoms. Thrombolysis has proved efficacy as adjunctive treatment in acute massive pulmonary embolism with right ventricular dilatation. Yet it shows no added benefit when used in haemodynamically stable patients Newer thrombolytic agents provide more efficacy in the form of rapid clot lysis, higher safety in the form of less bleeding complications Catheter-directed therapies have been shown to be safer and more effective than systemic infusions. Catheter-directed thrombolysis allows concentrated delivery of lytic agent, maximizing local effect while minimizing systemic bleeding complications.Mechanical devices, often used as adjuncts to lysis, offer the potential to extract clot even more efficiently and with added safety. The use of fluoroscopic guidance during endovascular procedures has often unveiled underlying anatomic abnormalities particularly in the iliac segment, which respond well to stenting. While a larger sample size would ideally be desired to reduce the degree of statistical uncertainty around these estimates, it should be recognized that enrollment to such studies offers a number of complex feasibility challenges. |