Tünay KURTOĞLU, Selim DURMAZ, Berent DİŞÇİGİL

Akut Derin Ven Trombozunda Endovasküler ve Cerrahi Tedavi

Akut derin ven trombozu (DVT) yüksek mortalite ve belirgin morbidite riskitaşımaktadır. Erken dönemde pulmoner embolizm (PE) ve venöz tıkanıklığa bağlıdolaşım bozukluğunun sonucu olan phlegmasia cerulea dolens en çok korkulankomplikasyonlardır. Ayrıca uzun dönemde Post-trombotik sendrom (PTS) yaşamkalitesinde ciddi azalmaya neden olabilmektedir. Antikoagülasyon akut DVT’detedavinin temelini oluşturmaktadır ve trombozun ilerlemesini engelleyerekölümcül PE riskini azalttığı kanıtlanmıştır. Ancak antikoagülan tedavi venözgangreni, venöz kapakçık yetmezliğini ve kronik venöz tıkanıklığın yol açtığı PTS’yiengellemekte yetersiz kalabilmektedir. Kateter aracılı trombolizis, perkütan mekaniktrombektomi, venöz anjiyoplasti/stentleme gibi endovasküler tedavi yaklaşımlarıve cerrahi venöz trombektomi, akut trombüs yükünün temizlemesini ve venözaçıklığı sağlayabilmektedir. Antikoagülasyon ile birlikte uygulanan bu yöntemler,ekstremiteyi tehdit eden venöz iskemide, iliofemoral trombozda ve PE riskininyüksek olduğu vena kava trombozunda öncelikli tedavi seçeneği haline gelmeyebaşlamıştır. Bu derlemede akut DVT tedavisinde kullanılan trombüs temizlemeyaklaşımlarının güncel literatür bilgileri eşliğinde gözden geçirilmesi amaçlanmıştır.

Endovascular and Surgical Treatment of Acute Deep Vein Thrombosis

Acute deep vein thrombosis (DVT) has a high mortality and a significant morbidity risk. The most dreadful early complications of DVT are pulmonary embolism (PE) and phlegmasia cerulea dolens, which is a consequence of circulatory impairment due to venous obstruction. Another important complication is Post-thrombotic syndrome (PTS), which may significantly reduce the quality of life in the long term. Anticoagulation is the cornerstone of treatment in DVT and has been proven to reduce the risk of fatal PE by avoiding thrombus propagation. However, anticoagulant therapy may be ineffective in preventing venous gangrene and PTS caused by chronic venous obstruction and venous valvular incompetence. Endovascular treatment options, such as catheter-directed thrombolysis, percutaneous mechanical thrombectomy, venous angioplasty/stenting and surgical venous thrombectomy, can help remove acute thrombus and restore venous patency. These methods can be performed as an adjunct to anticoagulant therapy and are becoming the treatment of choice in extremity-threatening venous ischaemia, as well as in iliofemoral venous thrombosis, and in vena cava thrombosis where the risk of PE is high. In this study, we aim to

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