J Korean Med Assoc.  2007 Jan;50(1):80-87. 10.5124/jkma.2007.50.1.80.

Interventional Radiologic Treatment of Deep Venous Thrombosis in Lower Extremity

• Won JH

• KMID: 2184798
• DOI: http://doi.org/10.5124/jkma.2007.50.1.80

Abstract

Deep vein thrombosis (DVT) is a common disease; however, it can result in significant disabilities from pulmonary embolism and postphlebitic syndrome, especially when the iliofemoral vein is involved. Although anticoagulation can prevent thrombus propagation and recurrent venous thrombosis, it cannot dissolve the occluding thrombus or reduce venous outflow obstruction, leaving the patients suffering from postphlebitic syndrome. Catheter-directed thrombolysis, with direct delivery of a concentrated lytic agent into the clot, has been proposed as an alternative therapy to anticoagulation. Recent studies have demonstrated that early clot lysis through this technique rapidly restores venous patency, more effectively preserves valvular function, and reduces a risk of postphlebitic syndrome. To decrease clot burden, duration of treatment, and bleeding complications, mechanical thrombectomy may work synergistically with catheter-directed thrombolysis. After clot removal through those therapies, balloon angioplasty and stent placement are needed in patients with venous stricture (eg, iliac vein compression syndrome). Short- and long-term outcomes of stenting in iliofemoral DVT appear to be favorable. When used in conjunction with each other and anticoagulation, these minimally invasive endovascular techniques allow a better resolution of venous clot burden and have the potential to lead to improved long-term outcomes in patients with DVT. This review introduces endovascular treatments of acute DVT in the lower extremities performed in the interventional radiology section.

Keyword

Deep vein thrombosis; thrombolysis; thrombectomy; percutaneous intervention

MeSH Terms

Angioplasty, Balloon
Constriction, Pathologic
Endovascular Procedures
Hemorrhage
Humans
Iliac Vein
Lower Extremity*
Postphlebitic Syndrome
Pulmonary Embolism
Radiology, Interventional
Stents
Thrombectomy
Thrombosis
Veins
Venous Thrombosis*

Figure

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  Figure 1 Multi-side hole infusion catheter. Thrombolytic drug are infused through multiple side holes of infusion catheter

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  Figure 2 A 59-year-old man with acute deep vein thrombosis (A) Ascending venography shows extensive thrombus in left iliofemoral vein (B) Multi- side- hole infusion catheter is embedded within thrombosed segment and urokinase is infused for 24 hours (C) After catheter directed thrombolysis, patency of the iliofemoral vein is restored

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  Figure 3 A 44-year-old woman with iliac compression syndrome (A) CT scan shows compressed left iliac vein (arrow) between right common iliac artery and vertebra body (B) Venography shows extrinsic compression of proximal left common iliac vein and collaterals to contralateral iliac vein (C) After placement of self expandable stent in left common iliac vein, venography shows widely patent left common iliac vein

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