Acute deep vein thrombosis and thrombolysis

Pulmonary embolism is a well-known and feared complication of deep venous thrombosis (DVT). Patients who present with acute DVT are treated with anticoagulation therapy whenever possible. Nonetheless, anticoagulation therapy does not actually treat DVT by dissolution of thrombus but instead prevents the propagation of the existing acute DVT. Unfortunately, a significant number of patients, particularly those with femoral or iliofemoral DVT, will develop the postthrombotic syndrome (PTS), despite receiving anticoagulation therapy. PTS is clinically manifested by leg pain, swelling, skin discoloration, and venous claudication; venous ulceration is the most severe form of PTS. The natural course of DVT is that of recanalization of the thrombosed segment, which may ultimately lead to venous insufficiency and/or reflux because of damage to the venous valves. Venous insufficiency, valvular incompetence, and reflux following DVT are known to play a major role in the development of PTS. Catheter-directed venous thrombolysis has been proposed as a means of reducing the risk of PTS, as this will actually dissolve the acute thrombus, restore venous patency, and, most importantly, restore venous valve function. This review examines the different techniques of thrombolysis and thrombectomy.