Endovascular Therapy for the Management of Acute Ilio-femoral Deep Vein Thrombosis

Abstract

Ilio-femoral deep vein thrombosis (DVT) has a high rate of long-term morbidity in the form of the postthrombotic syndrome (PTS). Therefore, management of acute thrombosis should not only focus on the prevention of acute complications such as propagation or embolisation of the initial clot but also on preventing recurrent thrombosis and PTS. Contemporary catheter-based treatments of deep vein thrombosis have proven to be safe and effective in selected patients. Current guidelines recommend medical therapy with anticoagulation alone for all but the most severe, limb-threatening thrombosis. They additionally allow for consideration of endovascular catheter-based treatment in selected patients with acute proximal ilio-femoral DVT and low risk of bleeding complications to prevent PTS. 

Imaging-guided, catheter-based endovascular therapy has been used in selected patients to alleviate these sequelae, but important questions remain about their optimal use. In this article, we review the available evidence and summarize the rationale for use of catheter-based therapy in specific patient groups with acute iliofemoral DVT.

Zusammenfassung

Bei der iliofemoralen tiefen Venenthrombose (TVT) besteht eine hohe Langzeit-Morbiditätsrate in Form des postthrombotischen Syndroms (PTS). Daher sollte sich die Behandlung einer akuten Thrombose nicht nur auf die Verhinderung von akuten Komplikationen wie Verschleppung oder Embolisation des ursprünglichen Gerinnsels konzentrieren, sondern auch auf die Verhinderung von rezidivierenden Thrombosen und PTS. Die aktuellen Katheter-gestützten Behandlungen der tiefen Venenthrombose haben sich bei bestimmten Patienten als sicher und wirksam erwiesen. Die aktuellen Leitlinien empfehlen eine medikamentöse Therapie mit Antikoagulation allein für alle außer der schwersten, die Gliedmaßen bedrohenden Thrombose. Sie ermöglichen zusätzlich die Einbeziehung einer endovaskulären Katheter-gestützten Behandlung bei bestimmten Patienten mit akuter proximaler iliofemoraler TVT und geringem Risiko von Blutungskomplikationen zur Verhinderung eines PTS. 

Eine bildgebungsgesteuerte, Katheter-gestützte endovaskuläre Therapie wird bei bestimmten Patienten eingesetzt, um diese Folgeerscheinungen zu lindern, aber es bestehen nach wie vor wichtige Fragen zu ihrem optimalen Einsatz. In diesem Artikel werden die vorliegenden Erkenntnisse betrachtet und die Gründe für den Einsatz der Katheter-gestützten Therapie bei speziellen Patientengruppen mit akuter iliofemoraler TVT zusammengefasst.

Key words

post-thrombotic syndrome - deep vein thrombosis - catheter-directed thrombolysis - endovascular therapy - pharmaco-mechanic thrombolysis - mechanic thrombectomy

Schlüsselwörter

postthrombotisches Syndrom - tiefe Venenthrombose - Katheter-gesteuerte Thrombolyse - endovaskuläre Therapie - pharmakomechanische Thrombolyse - mechanische Thrombektomie

Publication History

Article published online:
05 July 2021

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