Percutaneous options for acute deep vein thrombosis

Anticoagulant therapy is associated with poor late limb outcomes in many patients with deep vein thrombosis (DVT). Because systemic thrombolysis and surgical thrombectomy have inherent limitations, image-guided percutaneous thrombus removal is currently favored. Pharmacologic thrombolysis is effective in removing thrombus, but long-term benefit has not been conclusively demonstrated and major bleeding rates appear to be higher than those observed with anticoagulation alone. Percutaneous mechanical thrombectomy is limited as a stand-alone DVT treatment method by inability to clear large thrombosed veins completely and by pulmonary embolism. Pharmacomechanical thrombolysis represents the most promising currently available method to treat DVT. Randomized trials with long-term follow-up are needed to determine the appropriate indications for these procedures. In the meantime, a highly individualized approach to selection of patients is recommended, taking into account the chronicity and anatomic extent of DVT, the presence of circulatory compromise, the patient's bleeding risk profile, life expectancy, and anticipated activity level.