What is percutaneous transcatheter treatment for deep venous thrombosis (DVT)?

Updated: Dec 10, 2019
  • Author: Donald Schreiber, MD, CM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

Percutaneous transcatheter treatment of patients with deep venous thrombosis (DVT) consists of thrombus removal with catheter-directed thrombolysis, mechanical thrombectomy, angioplasty, and/or stenting of venous obstructions. In some cases, patients may also be given pulmonary embolism (PE) prophylaxis by means of filter placement in the inferior vena cava.

The goals of endovascular therapy include reducing the severity and duration of lower-extremity symptoms, preventing PE, diminishing the risk of recurrent venous thrombosis, and preventing postthrombotic syndrome (PTS).

The decision whether to use percutaneous transcatheter treatment and, if so, which technique to choose, is complicated by the lack of data from multicenter prospective randomized trials regarding the safety and efficacy of these therapies. Problems in the existing literature are variability in patient selection and the lack of standard definitions of short-term or long-term efficacy and complications. Nevertheless, a consensus regarding indications exists, although it is based on midlevel evidence from nonrandomized, controlled trials.

When an invasive procedure is considered, the benefit must be weighed against the added risk compared with standard anticoagulant therapy. If it is to be performed, the intervention must improve the results of current medical therapy. With heparin therapy, the risk of PE is 2%, the risk of recurrent DVT is 4%, and the risk of major bleeding is 5%.

More difficult to determine is the risk of PTS, which develops within 2 years in approximately one quarter of patients with symptomatic DVT and one half of those with proximal DVT. [1, 2, 3]

For more information, see Deep Venous Thrombosis.


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