Thrombosis

Thrombosis / 2017 / Article / Tab 1

Review Article

Pathogenesis of Thromboembolism and Endovascular Management

Table 1

Endovascular and surgical treatment methods for thrombus removal [1013].

Treatment modalityDescription/hallmarkPrototypical example

Pharmacologic thrombolysisAdministration of thrombolyticsCatheter-based, no adjunctive mechanical assistance
Systemic thrombolysisA thrombolytic is administered at an anatomic site disparate from the affected regionIntravenous catheter
Flow-directed thrombolysisIntravenous catheter used to administer a thrombolytic at an anatomic site within the extremity wherein the insult has occurred; tourniquets can be used to force flow towards the DVTIntravenous catheter and tourniquet
Catheter-directed thrombolysis (CDT)Drug delivery within the thrombosed vein and US energy directed into the thrombusInfusion catheter and US assisted catheter such as the EkoSonic catheter (EKOS, Bothell, WA)
Percutaneous mechanical thrombectomyThis modality can involve maceration, fragmentation, or aspiration; no thrombolytic is involvedCatheter-based mechanical device such as AngioVac
Pharmacomechanical CDTUse of CDT and mechanical techniques
First generation: can be initiated with CDT followed by mechanical technique (“infusion-first”) or vice versa (buzz-lyse)
Second generation: simultaneous maceration and infusion of a thrombolytic
First generation: multiple-side hole infusion catheter
Second generation: AngioJet, catheter-mounted balloon such as Trellis-8
Aspiration thrombectomyAspiration of a thrombus via a catheter using a syringeAspiration catheter with syringe
Balloon macerationUtilized to fragment and disperse thrombiAngioplasty balloon
Balloon angioplastyCatheter-mounted balloon which supports and enlarges the venous wallsAngioplasty balloon
Stent placementInsertion of a metallic endoprosthesis to maintain lumen patencyStent
Surgical thrombectomyVenotomySurgical instruments