Venous clot lysis and stenting
Hematology ASH Education Program
Venous thromboembolism (VTE) continues to represent a major source or mortality and morbidity. Although anticoagulation is the mainstay of therapy, adjunctive catheter-based interventions have shown substantial potential to improve clinically meaningful patient outcomes in patients with deep vein thrombosis (DVT), pulmonary embolism (PE), and the post-thrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) has been shown in a randomized trial to reduce the risk of PTS in patients with
... in patients with acute proximal DVT; data from a larger NIH trial is expected shortly. The use of CDT is being increasingly used for patients with submassive or massive pulmonary embolism. Preliminary studies suggest that endovascular stent placement and ablative therapies can improve quality-of-life in carefully selected patients with established PTS. In this article, we summarize the current status of thrombus removal and stent placement procedures for VTE and PTS, with the main purpose being to guide clinicians in individualizing treatment decisions for their challenging patients. Learning Objectives • Summarize the indications for endovascular treatment for patients with acute deep vein thrombosis, acute pulmonary embolism, and established post-thrombotic syndrome • Describe the results of a multicenter randomized trial that evaluated the use of catheter-directed thrombolysis as firstline therapy in patients with acute proximal DVT Conflict-of-interest disclosure: The author has received research funding from Covidien, Bayer Healthcare, Cook Inc, Volcano, and Therakos Inc; has received donation of a study drug from Genentech; and has received donation of stockings from BSN Medical. Off-label drug use: TPA for DVT thrombolysis Stents for venous use.