Wicky Stephan T
Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Tech Vasc Interv Radiol. 2009 Jun;12(2):148-53. doi: 10.1053/j.tvir.2009.08.008.
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.
肺栓塞是深静脉血栓形成（DVT）一种广为人知且令人恐惧的并发症。出现急性DVT的患者只要有可能就会接受抗凝治疗。然而，抗凝治疗实际上并非通过溶解血栓来治疗DVT，而是防止现有急性DVT的蔓延。不幸的是，相当多的患者，尤其是那些患有股静脉或髂股静脉DVT的患者，尽管接受了抗凝治疗，仍会发生血栓形成后综合征（PTS）。PTS的临床表现为腿部疼痛、肿胀、皮肤变色和静脉性跛行；静脉溃疡是PTS最严重的形式。DVT的自然病程是血栓形成段再通，这最终可能由于静脉瓣膜受损而导致静脉功能不全和/或反流。已知DVT后的静脉功能不全、瓣膜功能不全和反流在PTS的发生中起主要作用。导管定向静脉溶栓已被提议作为降低PTS风险的一种方法，因为这实际上将溶解急性血栓，恢复静脉通畅，并且最重要的是，恢复静脉瓣膜功能。本综述探讨了溶栓和血栓切除术的不同技术。
