Local thrombolysis for deep vein thrombosis: why, for whom and how?

Area of Science:

• Vascular Medicine
• Interventional Cardiology
• Thrombosis Research

Background:

• Venous thromboembolic disorder (VTD) poses a substantial medical burden, with an incidence of 100-200 per 100,000 annually.
• Deep vein thrombosis (DVT) survivors face risks of recurrence and post-thrombotic syndrome, impacting quality of life.

Purpose of the Study:

• To review the indications, technical aspects, and evidence for catheter-directed local thrombolysis in managing severe VTD.
• To highlight endovascular approaches as a viable alternative to traditional therapies.

Main Methods:

• Review of existing literature on catheter-directed thrombolysis for venous thromboembolism.
• Analysis of indications, procedural techniques, and clinical outcomes.
• Evaluation of efficacy in acute DVT and critical limb ischemia scenarios.

Main Results:

• Anticoagulation and compression are standard for acute VTD, but severe cases may require escalated therapy.
• Surgical embolectomy has high complication rates, making endovascular methods preferable.
• Catheter-directed thrombolysis demonstrates effectiveness, particularly in limb-threatening emergencies like phlegmasia.

Conclusions:

• Catheter-directed thrombolysis is an effective endovascular treatment for severe venous thromboembolic disorder.
• This minimally invasive approach offers a valuable alternative, especially in critical limb ischemia cases.
• Further evidence supports its role in improving outcomes for complex VTD presentations.