Endovaskuläre Rekanalisation chronischer Beckenvenenverschlüsse

Zusammenfassung

Die endovaskuläre Therapie von iliofemoralen Thrombosen wird in aktuellen nationalen und internationalen Leitlinien bei jungen Patienten zur Vermeidung eines postthrombotischen Syndroms als Therapieoption empfohlen. Hierzu stehen die endovaskuläre lokale Lysetherapie sowie pharmakomechanische oder rein mechanisch durchgeführte Techniken zur Verfügung. Die endovaskuläre Therapie von chronischen V.-cava-inferior- und Beckenvenenverschlüssen mit venösen Stents stellt eine effektive Therapie bei Patienten dar, die unter einem postthrombotischen Syndrom leiden. Hybridoperationen mit Anlage einer arteriovenösen Fistel (AV-Fistel) oder einer Endophlebektomie kommen bei einer Beteiligung der V. femoralis communis in Betracht.

Abstract

Current national and international guidelines recommend endovascular therapy of iliofemoral thromboses in young patients, as a treatment option to avoid the post-thrombotic syndrome. Possible techniques include endovascular local lysis therapy, as well as pharmacomechanical or purely mechanical procedures. Endovascular therapy of chronic obstruction of the inferior V. cava or pelvic veins is an effective therapy for patients suffering from post-thrombotic syndrome. If there is involvement of the V. femoralis communis, hybrid operations may be considered in which an AV fistula is formed or endophlebectomy is carried out.

Schlüsselwörter

Angioplastie - Antikoagulation - endovaskulärer Ultraschall - Thrombose

Key words

venous thrombosis - angioplasty - iliac vein stenting

• Literatur

• 1 White RH. The epidemiology of venous thromboembolism. Circulation 2003; 107: I4-I8
• 2 Akesson H, Brudin L, Dahlström JA. et al. Venous function assessed during a 5 year period after acute ilio-femoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg 1990; 4: 43-48
• 3 Cogo A, Lensing AW, Prandoni P. et al. Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound. Arch Intern Med 1993; 153: 2777-2780
• 4 Plate G, Akesson H, Einarsson E. et al. Long-term results of venous thrombectomy combined with a temporary arterio-venous fistula. Eur J Vasc Surg 1990; 4: 483-489
• 5 Kahn SR, Shapiro S, Wells PS. et al. Compression stockings to prevent postthrombotic syndrome: a randomized placebo-controlled trial. Lancet 2014; 383: 880-888
• 6 Kearon C, Akl E, Ornealas J. et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149: 315-352
• 7 Deutsche Gesellschaft für Angiologie (DGA). S2-Leitlinie: Diagnostik und Therapie der Venenthrombose und der Lungenembolie. 10. Oktober 2015. Im Internet: http://www.awmf.org/leitlinien/detail/ll/065-002.html Stand: 1.9.2017
• 8 Meissner MH, Gloviczki P, Comerota AJ. et al. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2012; 55: 1449-1462
• 9 Virchow R. Über die Erweiterung kleiner Gefäße. Arch Path Anat 1851; 3: 427
• 10 May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvis veins. Angiology 1957; 8: 419-426
• 11 Cockett FB, Thomas ML. The iliac compression syndrome. Br J Surg 1965; 52: 816-821
• 12 Oguzkurt L, Ozkan U, Ulusuan S. et al. Compression of the left common iliac vein in asymptomatic subjects and patients with left iliofemoral deep vein thrombosis. J Vasc Interv Radiol 2008; 19: 366-370
• 13 Chung JW, Yoon CJ, Jung SI. et al. Acute iliofemoral deep vein thrombosis: evaluation of underlying anatomic abnormalities by spiral CT venography. J Vasc Interv Radiol 2004; 15: 249-256
• 14 Fraser DG, Moody AR, Martel A. et al. Re-evaluation of iliac compression syndrome using magnetic resonance imaging in patients with acute deep venous thromboses. J Vasc Surg 2004; 40: 604-661
• 15 McDermott S, Oliveira G, Ergül E. et al. May-Thurner syndrome: can it be diagnosed by a single MR venography study?. Diagn Interv Radiol 2013; 19: 44-48
• 16 Arnoldussen CW, de Graaf R, Wittens CH. et al. Value of magnetic resonance venography and computed tomographic venography in lower extremity chronic venous disease. Phlebology 2013; 28 (Suppl. 01) S169-S175
• 17 Black S. VIRTUS trial update. VIVA Conference 2016. Las Vegas: 18 – 22 September 2016 [oral presentation].
• 18 Gagne P. Venography versus intravascular ultrasound for diagnosis of iliofemoral vein occlusive disease. VIDIO Trial, Charing Cross 2016. London, GB [oral presentation].
• 19 de Graaf R, Arnoldussen C, Wittens CH. Stenting for chronic venous obstructions a new era. Phlebology 2013; 28 (Suppl. 01) S117-S122
• 20 de Graaf R, de Wolf M, Sailer AM. et al. Iliocaval confluence stenting for chronic venous obstructions. Cardiovasc Intervent Radiol 2015; 38: 1198-1204
• 21 de Wolf MA, de Graaf R, Kurstjens RL. et al. Short-term clinical experience with a dedicated venous nitinol stent: initial results with the sinus-venous stent. Eur J Vasc Endovasc Surg 2015; 50: 518-526
• 22 Jalaie H, Arnoldussen C, Barbati M. et al. What predicts outcome after recanalization of chronic venous obstruction: hemodynamic factors, stent geometry, patient selection, anticoagulation or other factors?. Phlebology 2014; 29: 97-103