Thrombosen der Vena cava inferior – Ursachen und therapeutische Implikationen

Thrombosen, die die Vena cava inferior (VCI) betreffen bzw. involvieren, sind selten. Häufig ist die VCI nicht allein betroffen, sondern es finden sich auch Thrombosen, die aus den zuführenden Venensystemen wie Leber-, Nieren-, Ovarial- oder Becken-Beinvenen aszendiert sind. Gefäßanomalien, Autoimmun- und Tumorerkrankungen sind ätiologisch von Bedeutung. Je nach zugrunde liegender Pathologie ergeben sich Implikationen für die Therapiestrategie.

Abstract

Thromboses affecting or involving the inferior vena cava (VCI) are rare. Frequently, the VCI is not alone affected, but there are also thromboses that have ascended from the afferent venous systems such as the liver, kidneys, ovaries, or pelvic leg veins. Most abnormalities are discovered incidentally when abdominal imaging is performed for other reasons. Individuals with a congenital anomaly of the VCI have an increased risk of developing thrombosis at a young age. In addition, every 5th venous thromboembolism (VTE) is associated with cancer. Tumor diseases can contribute to thrombogenesis in the VCI through space-occupying processes. The most common tumor entities include renal cell carcinoma and other malignancies of the urogenital tract. Therapeutic anticoagulation is the therapy of choice, with direct oral anticoagulants (DOAC) being the preferred choice today. Mechanical revascularization procedures are particularly indicated to young patients, although evidence of a better long-term outcome is still lacking. The therapeutic strategy depends on the underlying pathology and must take all individual factors into account.

Kernaussagen

• Bei etwa 1–3 % aller Patienten mit einer tiefen Venenthrombose der unteren Extremitäten liegt eine VCI-Beteiligung vor.

• Patienten mit VCI-Thrombose sind durchschnittlich jünger als Patienten mit einer isolierten Beinvenenthrombose.

• Es lassen sich angeborene und erworbene Ursachen unterscheiden, wobei oftmals mehrere Faktoren zugleich vorliegen (multifaktorielle Thrombogenese).

• Die meisten Anomalien werden zufällig entdeckt, wenn eine abdominelle Bildgebung aus anderen Gründen durchgeführt wird.

• Personen mit kongenitaler Anomalie der VCI haben ein erhöhtes Risiko, bereits in jungen Jahren eine Thrombose zu entwickeln.

• Jede 5. venöse Thromboembolie (VTE) tritt malignomassoziiert auf.

• Tumorerkrankungen können durch raumfordernde Prozessen zur Thrombogenese in der VCI beitragen.

• Zu den häufigsten Tumorentitäten zählen dabei das Nierenzellkarzinom und andere Malignome des Urogenitaltrakts.

• Eine therapeutische Antikoagulation gilt als Therapie der Wahl, wobei heutzutage vorzugsweise direkte orale Antikoagulanzien (DOAK) eingesetzt werden.

• Mechanische Revaskularisationsverfahren sind besonders bei jungen Patienten indiziert, wobei weiterhin der überzeugende Nachweis eines besseren Langzeitverlaufs fehlt.

Schlüsselwörter

Antiphospholipidsyndrom - kongenitale Gefäßanomalie - Nierenzellkarzinom - Thrombose - Vena cava inferior

Keywords

antiphospholipid syndrome - congenital vascular anomaly - renal cell carcinoma - thrombosis - inferior vena cava

Publikationsverlauf

Artikel online veröffentlicht:
29. August 2022

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