Acute Venous Thrombosis: Thrombus Removal With Adjunctive Catheter-Directed Thrombolysis

Inclusion Criteria: * Symptomatic proximal DVT involving the iliac, common femoral, and/or femoral vein. Exclusion Criteria: * Age less than 16 years or greater than 75 years. * Symptom duration \> 14 days for the DVT episode in the index leg (i.e., non-acute DVT). * In the index leg: established PTS, or previous symptomatic DVT within the last 2 years. * In the contralateral (non-index) leg: symptomatic acute DVT a) involving the iliac and/or common femoral vein; or b) for which thrombolysis is planned as part of the initial therapy. * Limb-threatening circulatory compromise. * Pulmonary embolism with hemodynamic compromise (i.e., hypotension). * Inability to tolerate PCDT procedure due to severe dyspnea or acute systemic illness. * Allergy, hypersensitivity, or thrombocytopenia from heparin, rt-PA, or iodinated contrast, except for mild-moderate contrast allergies for which steroid pre-medication can be used. * Hemoglobin \< 9.0 mg/dl, INR \> 1.6 before warfarin was started, or platelets \< 100,000/ml. * Moderate renal impairment in diabetic patients (estimated glomerular filtration rate \[GFR\] \< 60 ml/min) or severe renal impairment in non-diabetic patients (estimated GFR \< 30 ml/min). * Active bleeding, recent (\< 3 mo) GI bleeding, severe liver dysfunction, bleeding diathesis. * Recent (\< 3 mo) internal eye surgery or hemorrhagic retinopathy; recent (\< 10 days) major surgery, cataract surgery, trauma, cardiopulmonary resuscitation, obstetrical delivery, or other …