Update on early thrombus removal for iliofemoral deep vein thrombosis

Abstract

Thrombus removal has for many years been attractive to investigate. The reasons were to relieve the acute symptoms with painful swelling and even to avoid tissue loss, but also with focus to decrease the incidence of late complications. Surgical procedures in the beginning and systemic thrombolysis years later were practiced in few dedicated centers. The breakthrough came 30 years ago in order to concentrate the lysis procedure directly into the thrombus material. This minimal invasive catheter-directed procedure was soon combined with stenting of the well-known iliac vein compression syndrome. Further development of this modality has taken place with some adjunctive mechanical devices primarily to minimize bleeding, which is the major concern of the methods. Less than ten RCT’s have been published over time, but conclusively supporting the rationale of early thrombus removal for iliofemoral DVT with reduction of PTS.

Zusammenfassung

Die Entfernung der Thromben aus einer Beinvene war über viele Jahre kontrovers diskutiert. Die Ergebnisse wurden untersucht, zum einen mit Blick auf die Entlastung der akuten Symptome einer Thrombose mit Schwellung, Schmerz, bis hin zum Gewebeverlust, aber auch mit dem Ziel der Verringerung später Komplikationen. In der Anfangszeit verfügte man nur über chirurgische Maßnahmen, später folgte die systemische Thrombolyse, diese Maßnahmen waren invasiv und wurden in wenigen spezialisierten Zentren vorgenommen.

Der Durchbruch geschah vor 30 Jahren, als die lokale Thrombolyse mit Wirkung direkt am Thrombose-Material eingeführt wurde. Es handelte sich um einen minimal-invasiven, Katheter-gestützten Eingriff, der bald kombiniert wurde mit dem Stenting bei bekannten Iliakal-Venen-Kompressionssyndromen. Es folgten technische Verbesserungen, insbesondere mit mechanischen Techniken, die auf eine Minimierung der bei diesen Maßnahmen immer befürchteten Blutungskomplikationen zielten. Weniger als 10 randomisierte kontrollierte Studien wurden über die Jahre veröffentlicht. Sie stimmen jedoch im Ergebnis überein: Bei einer frühen Entfernung der Thrombose im iliakalen Bereich entwickelt sich weniger häufig ein post-thrombotisches Syndrom.

Key words

Iliofemoral deep vein thrombosis - endovenous thrombus removal - surgical thrombectomy - post-thrombotic syndrome

Schlüsselwörter

Iliofemoralvenenthrombose - endovenöse Thrombectomie - chirurgische Thrombusentfernung - postthrombotisches Syndrome

• References

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