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Review
. 2017:2017:3039713.
doi: 10.1155/2017/3039713. Epub 2017 Jan 5.

Pathogenesis of Thromboembolism and Endovascular Management

Sasan Behravesh  1 , Peter Hoang  1 , Alisha Nanda  1 , Alex Wallace  1 , Rahul A Sheth  2 , Amy R Deipolyi  3 , Adnan Memic  4 , Sailendra Naidu  1 , Rahmi Oklu  1
Affiliations
Review

Pathogenesis of Thromboembolism and Endovascular Management

Sasan Behravesh et al. Thrombosis. 2017.

Abstract

Venous thromboembolism (VTE), a disease that includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is associated with high mortality, morbidity, and costs. It can result in long-term complications that include postthrombotic syndrome (PTS) adding to its morbidity. VTE affects 1/1000 patients, costs $13.5 billion annually to treat, and claims 100,000 lives annually in the US. The current standard of care for VTE is anticoagulation, though thrombolysis may be performed in patients with PE and threatened limb. This review discusses pathogenesis and medical treatment of VTE and then focuses on endovascular treatment modalities. Mechanical- and catheter-directed thrombolysis (CDT) is discussed, as well as patient selection criteria, and complications. The first prospective study (CaVenT) comparing CDT with anticoagulation alone in acute DVT, despite study shortcomings, corroborates the existing literature indicating improved outcomes with CDT. The potential of the ongoing prospective, multicenter, randomized ATTRACT trial is also highlighted.

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Conflict of interest statement

The authors declare no conflict of interests and have no financial disclosures.

Figures

Figure 1
Figure 1
US-assisted CDT of IVC thrombosis using EKOS device. (a) Coronal reformatted contrast enhanced CT image demonstrates an IVC filter with thrombosis extending to the iliac veins. (b) Following puncture of the common femoral veins, a bilateral EKOS device was placed and 0.5 mg/hr tPA was infused for 8 hours from each groin. (c) Postvenogram demonstrates complete resolution of the thrombus with minimal thrombus at the apex of the IVC filter. This filter was subsequently removed.
Figure 2
Figure 2
Mechanical thrombectomy of intrastent thrombosis using the AngioJet peripheral thrombectomy system. (a) Incomplete thrombosis of the IVC to iliac vein stents. (b) AngioJet thrombolysis was performed using 10 mg of tPA followed by thrombectomy. (c) Venogram reveals near-complete resolution of the thrombus.
Figure 3
Figure 3
Extensive suprarenal thrombosis extending to the iliac veins treated using the AngioVac system. (a) Coronal contrast enhanced CT demonstrating the suprarenal IVC thrombosis. (b) Venogram showing the IVC thrombosis. (c) AngioVac system within the IVC engaging the IVC thrombus (d). (e) Rotational thrombectomy system is used while the AngioVac system is engaged. (f) Mechanical thrombectomy using angioplasty balloons. (g) Postprocedure venogram reveals patent infrarenal IVC and iliac veins with residual chronic thrombosis. ((h) and (i)) Aspirated predominantly chronic thrombi are shown.
See this image and copyright information in PMC

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