Catheter directed thrombolysis – A new paradigm in the treatment of Deep Vein Thrombosis Deep vein thrombosis (DVT) is a major health problem. The risk of life threatening pulmonary embolism following DVT is well established, but the long-term vascular sequelae of DVT are often underappreciated, costly to manage, and can have extremely detrimental effects on quality of life. Treatment of DVT classically involves oral anticoagulation, which reduces the risk of pulmonary embolism but does not remove the clot. Anticoagulation therefore does little to prevent the venous damage and scarring that occurs following DVT, leaving the patient at risk for permanent venous insufficiency and development of post-thrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) is a endovascular treatment that is used as an adjunct to anticoagulation. CDT lowers the risk of PTS by reducing clot burden and protecting against valvular damage. A catheter is advanced directly to the site of thrombosis under fluoroscopy followed by a slow, prolonged infusion of a relatively low dose of thrombolytic agent. CDT restores venous patency faster than anticoagulation, which hastens the relief of acute symptoms. Numerous observational and retrospective studies have consistently shown a benefit of CDT plus anticoagulation over anticoagulation alone for prevention of PTS. Patients with long life expectancy and acute thrombosis involving the iliac and proximal femoral veins (iliofemoral DVT) have the greatest benefit from CDT, which may decrease the risk of PTS and/or decrease the severity of PTS symptoms if they do occur. CDT also plays an important role in those with acute limb-threatening venous occlusion or severe symptoms from DVT. Adverse outcomes are rare, which include risk of bleeding including intracranial haemorrhage. We did CDT in ~20 patients over a span of 7 yrs with 100% recanalization rate with one patient needed blood transfusion for drop in hemoglobin, the other patient developed local hematoma, and none of the cases developed intracranial bleed.