Recanalization after acute deep vein thrombosis

Abstract

The process of recanalization of the veins of the lower limbs after an episode of acute deep venous thrombosis is part of the natural evolution of the remodeling of the venous thrombus in patients on anticoagulation with heparin and vitamin K inhibitors. This remodeling involves the complex process of adhesion of thrombus to the wall of the vein, the inflammatory response of the vessel wall leading to organization and subsequent contraction of the thrombus, neovascularization and spontaneous lysis of areas within the thrombus. The occurrence of spontaneous arterial flow in recanalized thrombosed veins has been described as secondary to neovascularization and is characterized by the development of flow patterns characteristic of arteriovenous fistulae that can be identified by color duplex scanning. In this review, we discuss some controversial aspects of the natural history of deep vein thrombosis to provide a better understanding of its course and its impact on venous disease.Keywords: venous thrombosis; ultrasonography Doppler color; review literature as topic. ResumoO processo de recanalização das veias dos membros inferiores, após um episódio de trombose venosa profunda aguda em pacientes anticoagulados com heparina e inibidores da vitamina K, faz parte da evolução natural da remodelagem do trombo venoso. Esse complexo processo de remodelagem envolve a adesão do trombo à parede da veia, à resposta inflamatória da parede do vaso, levando à organização e subsequente contração do trombo, à neovascularização e à lise espontânea de áreas no interior do trombo. A presença de fluxo arterial espontâneo em veias com trombose recanalizada tem sido descrita como secundária à neovascularização e se caracteriza pelo desenvolvimento de fluxo com padrão de fístulas arteriovenosas, identificadas por meio de mapeamento dúplex colorido. Nesta revisão, são discutidos alguns aspectos controversos da história natural da trombose venosa profunda, para uma melhor compreensão da sua evolução e do seu impacto sobre a doença venosa.Palavras-chave: trombose venosa; ultrassonografia Doppler em cores; literatura de revisão como assunto.

Vasa Vasorum in Deep Vein Thrombus Recanalization

“…The same finding in the published literature by Brandao and his colleagues confirms this identification. 3 The phasic Doppler waveform in the proximal vein and the triphasic pulsatile Doppler waveform in the proximal artery confirmed that it was not an arteriovenous fistula. The spectral Doppler waveform of vasa vasorum also showed a flow at a low velocity (50 cm/s), which would be considered quite low for a working arteriovenous fistula.…”

“…1,2 When a vein thromboses, vasa vasorum engages in a process of recanalization. 3 The case study published by Brandao and his colleagues suggests that the visualization of vasa vasorum may indicate the process of recanalization may start earlier than how it is documented in most literatures. This current case study identifies vasa vasorum, and confirms its identification by the same findings as in the study by Brandao and his colleagues.…”

Factors Affecting Recanalization in Femoropopliteal Deep Vein Thrombosis

“…19 Currently, the use of DOACs is recommended by guidelines for the treatment of VTE. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]20 However, there are a few studies showing thrombus resolution after DVT using DOACs.…”

“…The aim of the DVT treatment is to relieve the symptoms, suppress the progression of thrombus, and prevent pulmonary thromboembolism and other complications secondary to DVT by inducing adequate anticoagulation. 2 After the development of femoropopliteal DVT, the competition between residual venous thrombosis (RVT) and recanalization determines the clinical course of DVT. 3 The extent and duration of the balance created between these 2 factors by DOACs or warfarin, a vitamin K antagonist used in the treatment of DVT, are unclear.…”