Endovascular management of venous thrombotic and occlusive disease of the lower extremities

Acute complications of deep vein thrombosis (DVT) of the lower extremities include pulmonary embolism and venous ischemia. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Anticoagulation therapy is recognized as the mainstay of therapy in acute DVT. However, there are few data to suggest any major beneficial effect on PTS, which is thought to be mediated by valve damage and/or occlusive chronic thrombus and venous scarring. Endovascular catheter-directed thrombolysis techniques with pharmacologic thrombolytic agents, used alone or in combination with mechanical thrombectomy devices, have been proven highly effective in clearing acute DVT, which may allow the preservation of venous valve function and prevention of subsequent venous occlusive disease. Definitive management of underlying anatomic occlusive abnormalities can also be undertaken.