Wiederherstellung der Leitvenen nach tiefer Becken-Beinvenenthrombose

Zusammenfassung

Hintergrund: Nach einer femoro-iliakalen und kavalen tiefen Venenthrombose (TVT) entwickeln bis zu 50 % der Patienten ein postthrombotisches Syndrom (PTS), was zu einer erheblichen Einschränkung der Lebensqualität führen kann.

Ergebnisse: Die Behandlungsmöglichkeiten bei einem PTS sind die konservative Therapie, klassische offene Bypass-Operationen sowie die endovaskulären Verfahren.

Zu den offenen Operationsverfahren liegen lediglich Studien mit geringer Fallzahl vor, deren Offenheitsrate 58–100 % beträgt. Die Komplikationen dieser invasiven Methode sind thrombotische Bypassverschlüsse, Hämatome und Wundheilungsstörungen.

Mit dem endovaskulären Verfahren können Offenheitsraten von 73–100 % erreicht werden. Zu diesem Verfahren liegen Studien mit größeren Fallzahlen vor. Als Komplikationen kann man einen thrombotischen Verschluss und Hämatome nennen.

Im Gegensatz zur konservativen Therapie gibt es zu den operativen Behandlungsmethoden keine randomisierten Studien. Aus diesem Grund kann für die operativen Verfahren nur eine schwache Empfehlung ausgespro-chen werden (Evidenzlevel II b).

Schlussfolgerung: Bei Vorliegen eines post-thrombotischen Syndroms mit chronisch venöser Obstruktion sollten zunächst alle konservativen Behandlungsmöglichkeiten ausgeschöpft werden. Bei weiterhin bestehenden Beschwerden mit deutlicher Einschränkung der Lebensqualität sollte ein invasives Therapieverfahren erwogen werden. In diesem Fall stellt die endovaskuläre Rekanalisation die Therapiemethode der ersten Wahl dar. Randomisierte Studien sind notwendig, um einen aussagekräftigeren Empfehlungsgrad zu erreichen.

Summary

Background: Postthrombotic syndrome (PTS) can develop in nearly 50 % of all patients who experience an iliofemoral and caval thrombosis which has a significant negative effect on the patients’ quality of life.

Results: Treatment options for PTS include conservative treatment, open surgical treatment and endovascular treatment of obstruction/occlusion.

The open surgical procedures are limited to studies with a low number of cases and have a patency rate of 58–100 %. The complications of these invasive methods are thrombotic occlusion of graft, hematomas and wound healing disorders.

A patency rate of 73–100 % can be achieved with the endovascular treatment. Studies with larger case numbers are available for this procedure. Thrombotic stent occlusion and hematomas can be mentioned as its complications. Unlike conservative therapies, there are no randomized studies on surgical treatment methods. As the result, only a weak recommendation level (II b) for the operative procedures has been suggested.

Conclusion: In a case of chronic venous obstruction (CVO), all conservative treatment options should first be exhausted. With furthermore existing complaints in the sense of PTS with a restriction of the quality of life, an invasive therapy procedure should be considered. In this case, the endovascular recanalization is the first choice of treatment. Randomized studies are necessary to achieve a better degree of recommendation.

Schlüsselwörter

PTS - TVT - Venenrekonstruktion

Keywords

PTS - DVT - vein reconstruction

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