ABSTRACT
Anticoagulant therapy is associated with poor late limb outcomes in many patients
with deep vein thrombosis (DVT). Because systemic thrombolysis and surgical thrombectomy
have inherent limitations, image-guided percutaneous thrombus removal is currently
favored. Pharmacologic thrombolysis is effective in removing thrombus, but long-term
benefit has not been conclusively demonstrated and major bleeding rates appear to
be higher than those observed with anticoagulation alone. Percutaneous mechanical
thrombectomy is limited as a stand-alone DVT treatment method by inability to clear
large thrombosed veins completely and by pulmonary embolism. Pharmacomechanical thrombolysis
represents the most promising currently available method to treat DVT. Randomized
trials with long-term follow-up are needed to determine the appropriate indications
for these procedures. In the meantime, a highly individualized approach to selection
of patients is recommended, taking into account the chronicity and anatomic extent
of DVT, the presence of circulatory compromise, the patient's bleeding risk profile,
life expectancy, and anticipated activity level.
KEYWORDS
Deep vein thrombosis - thrombolysis - thrombectomy - post-thrombotic syndrome - pharmacomechanical
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Suresh VedanthamM.D.
Associate Professor of Radiology and Surgery, Interventional Radiology Section, Mallinckrodt
Institute of Radiology
510 S. Kingshighway, Box 8131, St. Louis, MO 63110
