Interventional approaches to deep venous thrombosis

Purpose of review Catheter-directed therapy in deep vein thrombosis (DVT) is a beneficial adjunct treatment when anticoagulation alone does not provide an adequate therapeutic response. This review aims to deliver an up-to-date discussion behind the rationale, safety profile, and clinical outcomes in endovascular management of DVT. Recent findings Early studies have shown that the use of catheter-directed thrombolysis (CDT) to be successful in rapid thrombus removal, carry a lower incidence of postthrombotic syndrome (PTS), and improved quality of life. To date, the most robust study evaluating the use of CDT is the Catheter-Directed Venous Thrombolysis in Acute Iliofemoral Vein Thrombosis trial published in 2012, which demonstrated a relative risk reduction in PTS of 26% in the patients who received CDT at 2-year follow-up. The 5-year follow-up results from the trial has recently been published, which revealed persistent clinical benefit of CDT. Since, additional small randomized trials confer the efficacy and safety profile of CDT. Short-term results from pharmacomechanical catheter-directed thrombolysis are promising; however, the long-term efficacy has yet to be established. The recently completed Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis trial will be a pivotal study in defining the future role of pharmacomechanical catheter-directed thrombolysis in prevention of PTS. Summary CDT is a reasonable and well tolerated treatment option in selected patients with acute proximal DVT.