Table of Contents
Thrombosis
Volume 2017, Article ID 3039713, 13 pages
https://doi.org/10.1155/2017/3039713
Review Article

Pathogenesis of Thromboembolism and Endovascular Management

1Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
2Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
3Department of Interventional Radiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
4Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
5Center of Nanotechnology, King Abdulaziz University, Jeddah 21589, Saudi Arabia

Correspondence should be addressed to Rahmi Oklu; ude.oyam@imhar.ulko

Received 31 July 2016; Revised 13 November 2016; Accepted 27 November 2016; Published 5 January 2017

Academic Editor: Domenico Prisco

Copyright © 2017 Sasan Behravesh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Venous thromboembolism (VTE), a disease that includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is associated with high mortality, morbidity, and costs. It can result in long-term complications that include postthrombotic syndrome (PTS) adding to its morbidity. VTE affects 1/1000 patients, costs $13.5 billion annually to treat, and claims 100,000 lives annually in the US. The current standard of care for VTE is anticoagulation, though thrombolysis may be performed in patients with PE and threatened limb. This review discusses pathogenesis and medical treatment of VTE and then focuses on endovascular treatment modalities. Mechanical- and catheter-directed thrombolysis (CDT) is discussed, as well as patient selection criteria, and complications. The first prospective study (CaVenT) comparing CDT with anticoagulation alone in acute DVT, despite study shortcomings, corroborates the existing literature indicating improved outcomes with CDT. The potential of the ongoing prospective, multicenter, randomized ATTRACT trial is also highlighted.