Pathogenesis of Thromboembolism and Endovascular Management.
Venous thromboembolism (VTE), a disease that includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is associated with high mortality, morbidity, and costs. It can result in long-term complications that include postthrombotic syndrome (PTS) adding to its morbidity. VTE affects 1/1000 patients, costs $13.5 billion annually to treat, and claims 100,000 lives annually in the US. The current standard of care for VTE is anticoagulation, though thrombolysis may be performed in patients with PE and threatened limb. This review discusses pathogenesis and medical treatment of VTE and then focuses on endovascular treatment modalities. Mechanical- and catheter-directed thrombolysis (CDT) is discussed, as well as patient selection criteria, and complications. The first prospective study (CaVenT) comparing CDT with anticoagulation alone in acute DVT, despite study shortcomings, corroborates the existing literature indicating improved outcomes with CDT. The potential of the ongoing prospective, multicenter, randomized ATTRACT trial is also highlighted.
Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA; Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
Sasan
S
Behravesh
Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA; Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
Peter
P
Hoang
Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA; Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
Alisha
A
Nanda
Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA; Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
Alex
A
Wallace
Department of Interventional Radiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
Rahul A
RA
Sheth
Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
Amy R
AR
Deipolyi
Center of Nanotechnology, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
Adnan
A
Memic
Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA; Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
Sailendra
S
Naidu
Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA; Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
Rahmi
0000-0003-4984-1778
R
Oklu