Li Wenzhu, Vedantham Suresh, Jaffer Farouc A, Kakkos Stavros K, Galanaud Jean-Philippe, Dobesh Paul P, Fukaya Eri, Whipple Mary O, Alabi Olamide, Rosovsky Rachel P, Henke Peter K
Circulation. 2025 Jun 10;151(23):e1051-e1071. doi: 10.1161/CIR.0000000000001330. Epub 2025 May 13.
The "open vein hypothesis" postulates that early thrombus clearance and restoration of venous blood flow may prevent postthrombotic syndrome after proximal deep vein thrombosis. Since its proposal several decades ago, new insights from basic and clinical studies have motivated a re-evaluation and refinement of this hypothesis. According to data from these studies, susceptibility to postthrombotic syndrome occurs as a result of differences in genetic composition, thrombophilic conditions, predilection to inflammation and fibrosis, endogenous fibrinolytic capability, timing of symptom presentation and treatment initiation, and efficacy of antithrombotic therapy. Although initial restoration of an open vein appears to be beneficial for selected patient groups, freedom from postthrombotic syndrome is more likely in the setting of long-term venous patency, reduced recurrent thrombotic episodes, and reduced perithrombotic (eg, vein wall and valve) inflammation. These underlying biological mechanisms need further elucidation, with a long-term goal of personalizing treatment by mapping the individuals' clinical presentation with their underlying risk factors and assessing time-dependent biological processes that occur as a clinical venous thrombosis resolves. This scientific statement (1) highlights historical fundamentals of the open vein hypothesis and then showcases new research insights into the pathophysiological factors driving postthrombotic syndrome; (2) discusses advantages and disadvantages of imaging modalities for deep vein thrombosis used in clinical practice, including the potential to depict thrombus chronicity and status of vein wall injury; (3) proposes measures to develop integrated multidisciplinary care for deep vein thrombosis focused on the reduction of postthrombotic syndrome; and (4) identifies priority areas and questions for further research.
“开放静脉假说”假定，早期血栓清除和静脉血流恢复可预防近端深静脉血栓形成后的血栓形成后综合征。自该假说在数十年前提出以来，基础研究和临床研究的新见解促使人们对其进行重新评估和完善。根据这些研究的数据，血栓形成后综合征的易感性是由基因组成、血栓形成倾向、炎症和纤维化倾向、内源性纤维蛋白溶解能力、症状出现和治疗开始的时间以及抗血栓治疗的疗效等方面的差异导致的。尽管开放静脉的初始恢复似乎对特定患者群体有益，但在长期静脉通畅、复发性血栓形成事件减少以及血栓周围（如静脉壁和瓣膜）炎症减轻的情况下，更有可能避免出现血栓形成后综合征。这些潜在的生物学机制需要进一步阐明，其长期目标是通过将个体的临床表现与其潜在危险因素进行匹配，并评估临床静脉血栓溶解时发生的时间依赖性生物学过程，实现个性化治疗。本科学声明：（1）强调开放静脉假说的历史基础，然后展示对驱动血栓形成后综合征的病理生理因素的新研究见解；（2）讨论临床实践中用于深静脉血栓形成的成像方式的优缺点，包括描绘血栓慢性期和静脉壁损伤状态的潜力；（3）提出针对深静脉血栓形成制定综合多学科护理措施，以减少血栓形成后综合征；（4）确定进一步研究的重点领域和问题。
