From the Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104.
Radiographics. 2016 Sep-Oct;36(5):1565-75. doi: 10.1148/rg.2016150138.
The treatment for iliofemoral deep venous thrombosis (DVT) is challenging, as the use of anticoagulation alone can be insufficient for restoring venous patency and thus lead to prolongation of acute symptoms and an increased risk of chronic complications, including venous insufficiency and postthrombotic syndrome (PTS). In these cases, earlier and more complete thrombus removal can ameliorate acute symptoms and reduce long-term sequelae. Endovascular therapies involving the use of pharmacologic, mechanical, and combined pharmacomechanical modalities have been developed to achieve these goals. The most frequently used of these techniques, catheter-directed thrombolysis (CDT), involves the infusion of a thrombolytic agent through a multiple-side-hole catheter placed within the thrombosed vein to achieve high local doses and thereby break down the clot while minimizing systemic thrombolytic agent exposure. Randomized controlled trial results have indicated decreased PTS rates and improved venous patency rates in patients treated with CDT compared with these rates in patients treated with anticoagulation. The use of newer pharmacomechanical techniques, as compared with conventional CDT, reduces procedural times and thrombolytic agent doses and is the subject of ongoing investigations. Endovascular thrombus removal techniques offer a means to improve venous valvular function and decrease the risk of debilitating long-term complications such as PTS and are a promising option for treating patients with iliofemoral DVT. (©)RSNA, 2016.
髂股型深静脉血栓形成（DVT）的治疗颇具挑战性，因为单独使用抗凝治疗可能不足以恢复静脉通畅，从而导致急性症状持续时间延长，并增加慢性并发症（包括静脉功能不全和血栓后综合征（PTS））的风险。在这些情况下，更早、更完全地清除血栓可以改善急性症状并减少长期后遗症。为了实现这些目标，已经开发了涉及使用药物、机械和联合药物机械等方式的血管内治疗方法。这些技术中最常用的方法是经导管溶栓（CDT），它通过将多侧孔导管放置在血栓形成的静脉内来输注溶栓剂，以实现高局部剂量，从而分解血栓，同时最大限度地减少全身溶栓剂暴露。随机对照试验结果表明，与接受抗凝治疗的患者相比，接受 CDT 治疗的患者 PTS 发生率降低，静脉通畅率提高。与传统 CDT 相比，使用新型药物机械技术可减少手术时间和溶栓剂剂量，这是正在进行的研究的主题。血管内血栓清除技术为改善静脉瓣膜功能和降低 PTS 等致残性长期并发症的风险提供了一种手段，是治疗髂股型 DVT 患者的一种很有前途的选择。（©）RSNA，2016 年。
