Catheter-based techniques for therapy of deep vein thrombosis

Background. The postthrombotic syndrome (PTS) as a long-term consequence of deep vein thrombosis (DVT) is caused by venous obstruction and/or chronic insufficiency of the deep venous system. New endovascular therapies enable early recanalization of the deep veins aiming for reduced incidence and severity of PTS. Methods. A Medline search was performed for studies using catheter-directed thrombolysis (CDT) or thrombectomy (PMT) in DVT using the search terms deep venous thrombosis, catheter-directed thrombolysis and percutaneous mechanical thrombectomy. Results. The success of surgical thrombectomy depends on the age of the thrombosis. While systemic thrombolysis is not recommended due to the poor success rate (1 out of 4) and high risk of bleeding, catheter-derived thrombolysis (CDT) provides a more effective therapy with a significantly reduced risk of bleeding. Newer CDT systems combine thrombolysis with mechanical components in order to increase the effectiveness of this therapy; however, the available data are mainly derived from small case series. The CaVent study, a prospective randomized study with long-term results for CDT, revealed a reduction of PTS after 2 years for CDT compared to conservative therapy. Conclusion. Although the available data display the feasibility of catheter-based techniques, further prospective randomized studies are necessary to establish this therapy.