lliofemorale und iliocavale Interventionen bei tiefer Venenthrombose

Zusammenfassung

Bei der tiefen Venenthrombose (TVT) ist die spontane Thrombusauflösung nur selten zu erwarten. Die Thromben neigen im Gegenteil zur appositionellen Ausbreitung und zur Migration in die Lunge. Die Entwicklung einer chronisch venösen Insuffizienz infolge eines postthrombotischen Syndroms ist eine häufige Spätfolge der TVT. Therapieoptionen bei der tiefen Becken-Bein-Venenthrombose beinhalten die Antikoagulation sowie rekanalisierende Maßnahmen wie die Thrombolyse und die Thrombektomie. Der interventionell tätige Radiologe kann nach entsprechender Indikationsstellung eine nachweislich effektive und zügige minimalinvasive Gefäßrekanalisation durch lokoregionale Thrombolyse, pharmakomechanische Therapie oder, insbesondere iliocaval, rein mechanische Thrombektomie anbieten, wodurch nicht nur die Durchgängigkeit der betroffenen Venen wiederhergestellt wird, sondern zudem die Funktion der Venenklappen erhalten bleiben kann. Bei TVT mit rezidivierenden Lungenembolien können wiederentfernbare Filter mit verlängerter Implantationsdauer eingesetzt werden. Zur Behandlung von chronisch venösen proximalen Abflussstörungen und bei signifikanten Restengen nach Thrombolyse stellt die Ballonangioplastie mit Stentimplantation die Behandlungsmethode der Wahl dar. Der Radiologe kann daher in der Behandlung ausgedehnter venöser Erkrankungen eine wichtige Rolle einnehmen. Nachfolgend werden die Therapiemöglichkeiten bei der iliofemoralen und iliocavalen Thrombose aufgezeigt und erläutert.

Abstract

Significant spontaneous thrombus disintegration in deep venous thrombosis (DVT) occurs very infrequently. On the contrary, these thrombi are prone to appositional growth and migration into the pulmonary arteries. The development of chronic venous insufficiency due to postthrombotic syndrome is a frequent consequence of DVT. Therapeutic options in DVT include anticoagulation and recanalising procedures such as thrombolysis and thrombectomy. After appropriate indication assessment, the interventional radiologist can offer an efficacy-proven minimally-invasive vessel restitution approach by performing locoregional thrombolysis, pharmacomechanical therapy or, particularly in iliocaval thrombosis, mechanical thrombectomy. These methods not only serve to restitute of vessel patency, but also allow preserving venous valve function. In DVT with recurrent pulmonary embolism, retrievable filters with extended implantation duration can be deployed. In chronic proximal venous flow obstruction or in case of significant residual stenosis after thrombolysis, balloon angioplasty with stent implantation is the treatment modality of choice. Consequently, the radiologist can adopt an important role in the treatment of extensive venous disease. In this article, the treatment modalities concerning iliofemoral and iliocaval thrombosis are demonstrated and illustrated.

Key words

Veins, thrombosis - veins, transluminal angioplasty - stents and prostheses - thrombectomy - thrombolysis

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