Thrombolysis versus thrombectomy in acute deep vein thrombosis

Abstract

Thrombolysis versus thrombectomy in acute deep vein thrombosis reviewDeep vein thrombosis (DVT) is a significant health problem leading to the admission of over 250,000 Americans each year. Its most serious acute complication, namely pulmonary embolus kills approximately 100,000 each year, and is the third most common cardiovascular related mortality after myocardial infarction and stroke. Chronic leg problems following DVT include leg heaviness, tiredness, cramping and ulceration. These are termed the post-thrombotic syndrome. The current standard therapy of anticoagulation has changed little over 50 years. It does not remove or destroy thrombus, relying instead on the bodies own fibrinolytic mechanisms to do so. DVT needs to be more accurately categorized on an anatomical basis, and for a variety of reasons, the area of most importance is the iliofemoral region. The rationale for active, rather than passive, thrombus removal relies on multiple observations that, by doing so improves luminal patency, restores valvular function and has the potential to reduce the severity of post-thrombotic syndrome. Techniques of thrombus removal include catheter-directed thrombolysis, mechanical thrombectomy, and various combinations of both (pharmacomechanical catheter-directed thrombolysis). Although there no few direct trials comparing these directly, there is a reasonable body of evidence demonstrating their efficacy.

Diagnóstico y tratamiento de la trombosis venosa profunda

“…La trombólisis farmacológica dirigida por catéter, que elimina rápidamente el trombo venoso agudo, puede reducir la frecuencia de SPT. Las técnicas para la eliminación del trombo pueden ser de varios tipos: trombólisis asistida por catéter, trombectomía mecánica o una combinación de ambas, la trombectomía farmacomecánica 45 .…”