Liew Aaron, Douketis James
a Institute of Cellular Medicine , Newcastle University , Newcastle Upon Tyne , UK.
b Department of Medicine , McMaster University , Hamilton , Canada.
Expert Rev Cardiovasc Ther. 2016;14(2):189-200. doi: 10.1586/14779072.2016.1121096. Epub 2015 Dec 17.
In patients with extensive lower limb deep vein thrombosis (DVT) that, typically, extends into the iliofemoral veins, catheter-directed thrombolysis (CDT) can achieve faster and more complete thrombus lysis as compared with systemic thrombolysis, while providing an acceptable safety profile through administration of lower doses of thrombolytic agents. Through a reduction in thrombus burden, CDT has the potential to mitigate the risk for post-thrombotic syndrome by restoring venous patency and preserving venous valve function. The efficacy of CDT may be improved by adjunctive approaches that include percutaneous mechanical thrombectomy, angioplasty with or without stenting, and ultrasound-assisted CDT. CDT may also have a specific therapeutic role in the management of iliofemoral DVT involving patients who are pregnant or with May-Thurner syndrome. This article summarizes the literature in this area and discusses recently completed and ongoing randomized trials on the use of CDT in patients with extensive lower limb DVT.
在患有广泛下肢深静脉血栓形成（DVT）（通常延伸至髂股静脉）的患者中，与全身溶栓相比，导管定向溶栓（CDT）可实现更快、更完全的血栓溶解，同时通过给予较低剂量的溶栓剂提供可接受的安全性。通过减轻血栓负荷，CDT有可能通过恢复静脉通畅和保留静脉瓣膜功能来降低血栓后综合征的风险。包括经皮机械血栓切除术、有或无支架置入的血管成形术以及超声辅助CDT在内的辅助方法可能会提高CDT的疗效。CDT在涉及孕妇或患有May-Thurner综合征的患者的髂股DVT管理中也可能具有特定的治疗作用。本文总结了该领域的文献，并讨论了最近完成的和正在进行的关于在广泛下肢DVT患者中使用CDT的随机试验。
