Beckenvenenrekanalisation – Update zu akuten iliofemoralen Thrombosen

Die Inzidenz der tiefen Venenthrombose (TVT) beträgt in Westeuropa 1/1000 Einwohner pro Jahr [1]. Die TVT stellt die dritthäufigste kardiovaskuläre Mortalitätsursache [2] bedingt durch eine akute Lungenarterienembolie dar. Als Langzeitkomplikation kann sich durch die venöse Abflussstörung ein postthrombotisches Syndrom entwickeln. Neben der seit vielen Jahren etablierten konservativen Therapie wird die endovaskuläre Therapie der iliofemoralen TVT aufgrund der Evidenzsituation immer mehr angewendet.

Abstract

Deep vein thrombosis (DVT) is associated with a high-cost burden for health care systems because of secondary cost intensive complications like pulmonary embolism and especially the post thrombotic syndrome (PTS). Patients with PTS were found to retire from active work many years earlier which signifies a significant economic problem for public health. The current standard therapy of anticoagulation for DVT therapy has not changed through the years leaving patients especially with iliofemoral vein thrombus on a high risk situation for developing PTS. Current study situation for endovascular treatment of iliofemoral DVT treatment gives a rationale for active thrombus removal using catheter directed therapy (CDT) or pharmacomechanical thrombectomy (PMT) which improves valvular vein function and luminal patency reducing the potential complication of PTS. Based on the latest study results of randomized controlled trials and registry outcome data analyzing the efficacy and safety of CDT and PMT therapy these endovascular techniques may have the potential to change current guideline recommendations for the treatment of DVT.

Schlüsselwörter

Beckenvenenthrombose - postthrombotisches Syndrom - Thrombektomieverfahren - lokale Lysetherapie - Antikoagulation

Keywords

iliofemoral vein thrombosis - post thrombotic syndrome - venous thrombectomy - catheter directed thrombolysis - mechanical thrombectomy - anticoagulation

Publication History

Article published online:
10 February 2023

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