Especially if the iliac veins are scarred down and there is chronic occlusion. I treat a lot of post thrombotic patients and they do very well after treatment. Key is posterior tibial vein access and treatment of the entire leg and pelvis.

Agree about the tpa and EKOS though. Potential risk of bleeding with no real benefit. There is a well known IR who drips every patient with dvt not matter the chronicity but I have not found it to be helpful. What I find is mostly organized thrombus with scar tissue and deep venous occlusion.