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Deep venous thrombosis is a significant cause of
morbidity and mortality. It has been estimated that
the yearly incidence of deep venous thrombosis is high
and many individuals die annually from pulmonary
emboli. In addition to early risk of pulmonary emboli,
later morbidity may develop from recurrent
thrombosis and post thrombotic syndrome.
Endovascular deep venous thrombosis
thrombolysis offers the potential to provide faster
relief of presenting deep venous thrombosis symptoms
and to prevent post-thrombotic syndrome and its
associated major disability.
Urgent thrombolysis is required to treat
phlegmasia cerula dolens or progressive inferior vena
cava thrombosis.Thrombolysis may also be useful to
prevent post thrombotic syndrome. Thrombolysis
alone, mechanical devices alone, or a combination can
be used; also can insert stent in the thrombotic part.
To confirm that existing percutaneous methods
of treating acute deep venous thrombosis indeed
produce favorable outcomes, we urgently need supporting randomized clinical trials. Until they are
completed, a highly individualized approach to patient
selection optimizes clinical benefit.
Contemporary venous thrombectomy has
substantially improved early and long-term results for
patients with extensive DVT compared to the initial
reports. Recent reports of those performing venous
thrombectomy and the long-term results of the large
Scandinavian randomized trial confirm significant
benefit compared to anticoagulation alone. Therefore,
vascular surgeons should include contemporary
venous thrombectomy as part of their routine
operative armamentarium and offer it to patients with
IFDVT who cannot receive catheter-directed
techniques for thrombus removal.
Iliac vein stenting has emerged as a powerful
new minimally invasive technique for treatment of a
wide spectrum of advanced venous disease. The
procedure is safe and effective. As a result, it can be
applied to a wider spectrum of patients, including
those of advanced age and with comorbidities, which
is not possible with traditional open techniques.