Thromb Haemost 2005; 93(05): 801-809
DOI: 10.1160/TH04-09-0596
Review Article
Schattauer GmbH

The role of neovascularisation in the resolution of venous thrombus

Bijan Modarai
1  Academic Department of Surgery, Cardiovascular Division, St Thomas’ Hospital, King’s College, London, UK
,
Kevin Guiver Burnand
1  Academic Department of Surgery, Cardiovascular Division, St Thomas’ Hospital, King’s College, London, UK
,
Julia Humphries
1  Academic Department of Surgery, Cardiovascular Division, St Thomas’ Hospital, King’s College, London, UK
,
Matthew Waltham
1  Academic Department of Surgery, Cardiovascular Division, St Thomas’ Hospital, King’s College, London, UK
,
Alberto Smith
1  Academic Department of Surgery, Cardiovascular Division, St Thomas’ Hospital, King’s College, London, UK
› Author Affiliations
Grant support: Bijan Modarai was supported by the British Heart Foundation and a grant from the Guy’s and St Thomas’ Charitable Foundation.
Further Information

Publication History

Received 15 September 2004

Accepted after resubmission 04 February 2005

Publication Date:
11 December 2017 (online)

Summary

Deep vein thrombosis (DVT) can give rise to chronic debilitating complications, which are expensive to treat. Anticoagulation, the standard therapy for DVT, prevents propagation, but does not remove the existing thrombus, which undergoes slow natural resolution. Alternative forms of treatment that accelerate resolution may arise from a better understanding of the cellular and molecular pathways that regulate the natural resolution of thrombi. This review will outline our current understanding of the mechanisms of thrombus resolution and the role of neovascularisation in this process. Novel experimental treatments that may one day find clinical use are also discussed. The process of thrombus resolution resembles wound healing. The mainly monocytic inflammatory infiltrate, which develops, is associated with the appearance of vascular channels. These cells may drive resolution by encouraging angiogenesis, which contributes to restoration of the vein lumen. Significant numbers of bone marrow-derived progenitor cells have also been found in naturally resolving thrombi, but their precise phenotype and their role in thrombus recanalisation is unclear. Enhanced thrombus neovascularisation and rapid vein recanalisation have been achieved in experimental models with proangiogenic agents. Recent reports of the role of bone marrow-derived progenitor cells in the revascularisation of ischaemic tissues suggest that it may be possible to obtain the same effect by delivering pluripotent or lineage specific stem cells into thrombus. These cells could contribute to thrombus recanalisation by expressing a variety of proangiogenic cytokines or by lining the new vessels that appear within the thrombus.