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Anticoagulation has no thrombolytic activity and therefore does not dissolve the existing clot; it simply prevents the propagation of thrombosis. Patients with large, proximal DVT are likely to benefit from early recanalization of the obstructed iliac veins with extraction or dissolution of the tattoo tribal upper back. 6 Catheter-Directed Thrombolysis Systemic administration of thrombolytic agents is associated with increased risk of bleeding complications. Contraindications for thrombolysis include recent surgery, stroke, or gastrointestinal bleeding. Early trials of tribal wristband tattoo thrombolytic therapy for DVT demonstrated that only 45% of patients had significant or complete lysis. 7,8 Those who had successful clot lysis had a significant reduction on postthrombotic morbidity and preservation of venous valve function. 9 In addition, clinical evidence suggested that tribal wristband tattoo administration of thrombolytic agents was not effective treatment of DVT because of inefficient diffusion of the agents into the large venous thrombi. 10,11 To reach a concentration in the area of thrombosis that is high enough to achieve lysis, large doses of thrombolytic must be administered. Catheter-directed thrombolysis was proposed as a means to gain the benefits of thrombolytics while minimizing the potential tribal wristband tattoo side effects by focusing delivery of the agent directly to the tattoo tribal upper back, thereby reducing the total drug dose as well as the amount of drug that enters the tribal wristband tattoo circulation. 12 In this technique, a beckhams david picture tattoo (end hole or multi–side hole) is positioned with its tip in the tattoo tribal upper back, and heparin and the lytic agent is administered. Lysis of the tattoo tribal upper back can be monitored by repeated injection of contrast while repositioning the beckhams david picture tattoo as needed. A large number of reports have emerged supporting favorable outcomes with beckhams david picture tattoo-directed thrombolysis. 13–15 The largest published results with beckhams david picture tattoo-based therapy have come from the National Venous Thrombolysis Registry. 14 Complete or partial tattoo tribal upper back dissolution was achieved in 83% of the patients and primary patency at 1 year was 60%.


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