Valvular dysfunction and venous obstruction in the post-thrombotic syndrome.
Medical thrombosis physicians have tended to view deep vein thrombosis (DVT) as essentially a problem of biology and hematology. This "field condition" concept holds that in susceptible individuals, DVT risk factors lead to a global hypercoagulable state which results in venous thrombosis. However, less attention has been paid to the key problems of venous anatomy and physiology that lead to the post-thrombotic syndrome (PTS) and its major health consequences. The primary objectives of this article are: (1) to review the macroscopic pathophysiology of PTS; (2) to discuss the roles of valvular reflux and venous obstruction in the development of PTS; and (3) to explore new endovascular PTS prevention and treatment strategies that feature the prevention or elimination of valvular reflux and late venous obstruction to improve DVT patient outcomes.
Vedantham
Suresh
S
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA. vedanthams@mir.wustl.edu
D000818:Animals; D000925:Anticoagulants / Q000627:therapeutic use; D002404:Catheterization; D003131:Combined Modality Therapy; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D053685:Laser Therapy; D054070:Postthrombotic Syndrome / Q000473:pathology / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy; D012008:Recurrence; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D055422:Venous Valves / Q000473:pathology / Q000503:physiopathology*
D000925:Anticoagulants; D005343:Fibrinolytic Agents