Neue endovaskuläre Behandlungsmöglichkeiten der tiefen Venenthrombose

Zusammenfassung

Die Standardtherapie der tiefen Beinvenenthrombose (TVT) umfasst die Kombination aus Antikoagulation, Kompressionsbehandlung und Mobilisation. Obwohl diese Therapie das Risiko für ein postthrombotisches Syndrom (PTS) reduziert, entwickelt sich ein solches bei immer noch 25 % aller iliofemoralen Thrombosen innerhalb von 2 Jahren. Das Spektrum der Therapien zur Thrombusentfernung ist durch neue endovaskuläre Techniken erweitert worden. Die Therapien können möglicherweise durch eine frühzeitige Rekanalisation der tiefen Venen das PTS-Risiko reduzieren. Ziel dieser Übersicht ist es, neben der Diagnostik der TVT insbesondere die neuen Therapiemöglichkeiten vorzustellen. Die bisherigen Ergebnisse zeigen für verschiedene Systeme zur kathetergesteuerten Thrombolyse und perkutanen mechanischen Thrombektomie sehr gute primäre Erfolgsraten und eine Offenheitsrate > 80 % in der Nachbeobachtung. Ergänzt werden diese Verfahren durch die endovaskuläre Stentangioplastie, um verbleibende oder ursächliche venöse Stenosen zu behandeln. Die vielversprechenden Ergebnisse deuten auf das Potenzial von kathetergesteuerten Verfahren zur Behandlung der iliofemoralen TVT hin.

Abstract

The standard treatment of deep vein thrombosis (DVT) consists of anticoagulation, compression therapy and mobilization. Although this therapy reduces the risk of post thrombotic syndrome (PTS), in 25 % of patients with iliofemoral DVT a post-thrombotic syndrome is developing within 2 years. New endovascular techniques facilitate early thrombus removal and recanalization of the deep veins. Hereby, they might reduce the risk of PTS. In addition to the diagnosis of DVT, this review focusses particularly on new treatment options for DVT. The available results using catheter-guided thrombolysis or percutaneous mechanical thrombectomy show very good primary success rates and a patency rate over 80 % during follow-up. These procedures are supplemented by endovascular stent angioplasty to treat the remaining venous stenoses. These promising results demonstrate the potential for catheter-guided procedures for treatment of ilio-femoral DVT.

Schlüsselwörter

tiefe Venenthrombose - postthrombotisches Syndrom - kathetergesteuerte Thrombolyse - perkutane mechanische Thrombektomie - Stentangioplastie

Keywords

deep vein thrombosis - postthrombotic syndrome - catheter-directed thrombolysis - percutaneous mechanical thrombectomy - stent angioplasty

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