Abstract:Objective To compare the clinical efficacy and safety of AngioJet thrombectomy with sequential low-dose urokinase thrombolysis versus catheter-directed thrombolysis(CDT) in the treatment of acute iliofemoral deep venous thrombosis (DVT). Methods A total of 46 patients with acute iliofemoral DVT treated at Jiangsu Province Hospital of Chinese Medicine from January 2019 to December 2022, were randomly assigned into two groups using a random number table: 23 patients in the AngioJet thrombectomy with sequential low-dose urokinase thrombolysis group (AngioJet group) and 23 patients in the CDT group. The following outcomes were compared between the groups: the reduction rate of lower limb swelling 1 day post-surgery, venous patency rates at 1 day and 12 months post-surgery, urokinase usage, hospital stay, and safety parameters (bleeding, local infection, and thrombus recurrence). Results On day 1 post-surgery, the AngioJet group showed a significantly higher reduction rate of lower limb swelling ［thigh: (81.35±6.78)% vs (43.56±7.32)%，t=6.107; calf: (78.16±8.45)% vs (46.54±8.62)%, t=11.735］ and a higher venous patency rate ［（90.68±17.89% vs (68.56±15.34)%, t=6.478］ compared to the CDT group (P＜0.05). The AngioJet group also used significantly less urokinase, had a lower incidence of bleeding, a shorter length of hospital stays, and a lower incidence of post-thrombotic syndrome (PTS) at 12 months (P＜0.05). There was no significant difference between the two groups in terms of catheter-related infections, thrombus recurrence, or venous patency at 12 months (P＞0.05). Conclusion AngioJet thrombectomy with sequential low-dose urokinase thrombolysis provides faster relief of lower limb swelling, a higher venous patency rate, shorter hospital stays, and a lower incidence of PTS, with higher safety in the treatment of iliofemoral DVT.