Endovascular Therapies in Acute DVT

Traditionally, DVTs have been treated with the use of oral anticoagulation medication (such as warfarin) for a period of 6 months. However, this is associated with a high risk for recurrent thrombosis, and approximately one third will develop post thrombotic syndrome despite treatment (Prandoni et al 1996). The recurrence of DVT is thought to be related to damage to the venous valves during an episode of thrombosis and the low rate of recanalisation particularly in caval/iliac/femoral venous thrombosis, which leads to obstruction and venous hypertension. It has been suggested that anticoagulation therapy alone may be inadequate to prevent the damage to the venous valves in the setting of caval/iliac/femoral DVT. Moreover, it has been shown that early thrombus removal is associated with a lower incidence of symptoms related to post thrombotic syndrome (Sharafuddin 2003). These factors have prompted use of invasive techniques such as catheter directed thrombolysis and mechanical thrombectomy, particularly in the acute setting, for thrombus removal.