Interventional approaches to deep vein thrombosis

Abstract

The last decade has seen increased use of aggressive, catheter-based methods of treating deep vein thrombosis (DVT). In this article, we outline the risks, benefits, and uncertainties surrounding endovascular DVT therapies, describe clinical situations in which endovascular treatment options should reasonably be considered, and update the reader on new outcome data that pertains to catheter-based DVT interventions. Endovascular thrombolytic therapy is reasonable to perform for selected patients with DVT causing acute limbthreatening circulatory compromise, acute inferior vena cava occlusion, or acute iliofemoral DVT for the purposes of limb salvage and relief of presenting DVT symptoms, and appears likely to prevent post-thrombotic syndrome (PTS) in patients with proximal DVT. A multicenter randomized trial, the ATTRACT Study, is currently underway in the United States to determine whether pharmacomechanical catheter-directed thrombolysis (PCDT) is sufficiently safe and effective to be recommended for routine use in proximal DVT patients. Selected patients with established moderate-to-severe PTS in association with an occluded iliac vein or a refluxing saphenous vein may also be amenable to endovascular intervention to reduce venous hypertension, alleviate symptoms, and improve limb function and quality of life. Pending the results of further studies, an individualized approach to patient selection for interventional DVT therapies is recommended. Am. J. Hematol. 87:S113-S118, 2012. V

Pharmacomechanical Thrombolysis of Symptomatic Acute and Subacute Deep Vein Thrombosis with a Rotational Thrombectomy Device

“…During the past decade, PMT has emerged as an effective alternative to open surgical thrombectomies and catheter-directed thrombolysis (CDT) in patients with acute DVT (2). Pharmacomechanical approaches have been suggested as viable and possibly preferable approaches to the management of acute DVT (3).…”

Acute Pancreatitis Complicated by Massive Inferior Vena Cava and Right Atrial Thrombosis: A Case Report

“…12 Thrombolysis or mechanical thrombectomy may be indicated in patients with occlusive symptoms. 13 In this case, anticoagulation combined with mechanical thrombectomy of the thrombus would have been a favorable treatment strategy, but mechanical thrombectomy was not undertaken because the patient's general condition did not support the surgery and the patient showed no lifethreatening occlusive symptoms. We think the patient died from septic complications because the patient showed persistent fever and low blood pressure, in spite of aggressive antibiotic treatment.…”

Ultrasound Assisted Endovascular Thrombolysis in Adolescents: 2 Case Reports

“…14 Due to the bleeding risk of systemic lysis and the high risk of rethrombosis after surgical procedures, different methods for local lysis with reduced recombinant tissue plasminogen activator (rtPA) dosing have been established over the last few decades. 14,15 Catheterdirected thrombolysis in adults experiencing descending iliofemoral DVT is an accepted therapeutic tool to restore patency as quickly as possible. 15,16 Percutaneous endovascular thrombolysis includes: (1) mechanical aspiration of thrombi; and (2) catheter-directed thrombolysis and, as a recent development, an additional highfrequency, low-power ultrasound.…”

“…14,15 Catheterdirected thrombolysis in adults experiencing descending iliofemoral DVT is an accepted therapeutic tool to restore patency as quickly as possible. 15,16 Percutaneous endovascular thrombolysis includes: (1) mechanical aspiration of thrombi; and (2) catheter-directed thrombolysis and, as a recent development, an additional highfrequency, low-power ultrasound. 15,17 Ultrasound causes a disaggregation of fibrin fibers, and pressure waves increase thrombus penetration of thrombolytic agents.…”

“…15,16 Percutaneous endovascular thrombolysis includes: (1) mechanical aspiration of thrombi; and (2) catheter-directed thrombolysis and, as a recent development, an additional highfrequency, low-power ultrasound. 15,17 Ultrasound causes a disaggregation of fibrin fibers, and pressure waves increase thrombus penetration of thrombolytic agents. 18 A multicenter, randomized study in adults reported a decreased incidence of PTS (from 55% to 37%) compared with standard anticoagulation therapy.…”