Endovascular management of acute deep vein thrombosis

The goals of successful management of deep vein thrombosis (DVT) include relief of acute symptoms with restoration of venous patency, prevention of clot propagation and subsequent pulmonary embolism, and maintenance of venous valvular function. Valvular incompetence is the leading cause of postthrombotic syndrome (PTS), which is characterized by chronic leg heaviness and aching, lower extremity edema, and impaired viability of subcutaneous tissues, which may lead to chronic trophic skin changes and venous ulceration. Anticoagulation with unfractionated or low-molecular-weight heparin followed by warfarin is recognized as the standard therapy for acute DVT. Although this approach may effectively prevent recurrent thrombosis, it often fails to meet the other treatment goals. Recent studies have demonstrated that early clot lysis through the use of catheter-directed thrombolytic therapy and other adjunctive endovascular techniques rapidly restores venous patency, more effectively preserves valvular function, and improves quality of life. When used in conjunction with anticoagulation, these minimally invasive endovascular techniques have the potential to lead to improved long-term outcomes in patients with DVT.