Department of Bioengineering, The University of Texas at Arlington, Arlington, TX 76019, USA.
Joint Biomedical Engineering Program between The University of Texas at Arlington and The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Biotechnol Adv. 2013 Sep-Oct;31(5):504-513. doi: 10.1016/j.biotechadv.2012.08.004. Epub 2012 Aug 23.
Deep vein thrombosis (DVT) affects up to 2 million people in the United States, and worldwide incidence is 70 to 113 cases per 100,000 per year. Mortality from DVT is often due to subsequent pulmonary embolism (PE). Precise diagnosis and treatment is thereby essential for the management of DVT. DVT is diagnosed by a thorough history and physical examination followed by laboratory and diagnostic tests. The choice of laboratory and diagnostic test is dependent on clinical pretest probability. Available laboratory and diagnostic techniques mainly involve D-dimer test, ultrasound, venography, and magnetic resonance imaging. The latter two diagnostic tools require high doses of contrast agents including either radioactive or toxic materials. The available treatment options include lifestyle modifications, mechanical compression, anticoagulant therapy, inferior vena cava filter, and thrombolysis/thrombolectomy. All of these medical and surgical treatments have serious side effects including improper clot clearance and increased risk of hemorrhage occurrence. Therefore, research in this field has recently focused on the development of non-invasive and accurate diagnostics, such as ultrasound enhanced techniques and molecular imaging methods, to assess thrombus location and its treatment course. The frontier of nanomedicine also shows high prospects in tackling DVT with efficient targeted drug delivery. This review describes the pathology of DVT along with successive medical problems such as PE and features a detailed listing of various diagnostic and therapeutic modalities that have been in use and are under development.
深静脉血栓形成(DVT)在美国影响多达 200 万人,全球发病率为每年每 10 万人中有 70 至 113 例。DVT 导致的死亡率通常是由于随后发生的肺栓塞(PE)。因此,精确的诊断和治疗对于 DVT 的管理至关重要。DVT 通过详细的病史和体格检查,以及实验室和诊断测试来诊断。实验室和诊断测试的选择取决于临床前期概率。现有的实验室和诊断技术主要涉及 D-二聚体测试、超声、静脉造影和磁共振成像。后两种诊断工具需要使用高剂量的造影剂,包括放射性或有毒物质。现有的治疗选择包括生活方式改变、机械压迫、抗凝治疗、下腔静脉滤器和溶栓/血栓切除术。所有这些医疗和手术治疗都有严重的副作用,包括不正确的血栓清除和增加出血发生的风险。因此,该领域的研究最近集中在开发非侵入性和准确的诊断方法,如超声增强技术和分子成像方法,以评估血栓的位置及其治疗过程。纳米医学的前沿也显示出在高效靶向药物输送方面治疗 DVT 的广阔前景。本综述描述了 DVT 的病理学以及随后的 PE 等医疗问题,并详细列出了已在使用和正在开发中的各种诊断和治疗方法。