Endovenöse Rekanalisationen von chronischen Beckenvenenverschlüssen

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Pathophysiologie Eine persistierende venöse Ausstromobstruktion nach iliofemoraler Thrombose führt bei vielen Patienten zu den Symptomen eines postthrombotischen Syndroms, wobei bereits eine persistierende Beinschwellung und venöse Claudicatio eine Einschränkung der Lebensqualität bedeuten kann.

Endovaskuläre Therapie Anspruchsvolle endovaskuläre Rekanalisationstechniken in Spezialkliniken ermöglichen die Wiedereröffnung von jahrelang bestehenden chronischen Verschlüssen der Vena cava inferior und der Beckenvenen.

Neue venöse Stentgeneration Inzwischen liegen immer mehr klinische Sicherheits- und Effektivitätsdaten für die neue Generation von Venenstents vor. Bei der Auswahl eines Stents sollte auf die jeweilige physikalische Eigenschaft des Stents geachtet werden, die sich teilweise sehr unterschiedlich zeigt bei den inzwischen neun in Europa zugelassenen venösen Stents.

Abstract

Approximately 60 % of patients with acute iliofemoral deep vein thrombosis recover without further symptoms. However, 40 % will have some degree of post-thrombotic syndrome (PTS) and 4 % will develop severe PTS. PTS is the most common complication; it reduces quality of life and increases DVT-related costs. The clinical symptoms and severity of PTS may vary; the most common symptoms include edema, pain, hyperpigmentation, lipodermatosclerosis, and ulceration. PTS is based on the principle of outflow obstruction, may be caused by venous hypertension, and may lead to valvular damage and venous reflux or insufficiency. A significant lumen reduction within the iliac vein system is defined by an aspect ratio ≥ 2. Recent technical developments and new dedicated venous stent techniques now give the opportunity to recanalize even complex venous outflow obstructions. First in man safety and efficacy data are very promising for the new dedicated venous stents, but long-term data are still missing.

Schlüsselwörter

Beckenvenenstenose - postthrombotisches Syndrom - ilio-femorale Venenthrombose - venöse Rekanalisation - Venenstents

Key words

iliofemoral venous obstruction - post-thrombotic syndrome - venous recanalization - venous stents

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