ABSTRACT
PART 1: INTRODUCTION Acute deep venous thrombosis (DVT) represents a disease spectrum ranging from asymptomatic calf vein thrombosis to the painful swollen limb of phlegmasia cerulea dolens resulting from extensive multisegment DVT. Although patient presentation and extent of venous thrombosis vary considerably, national and international guidelines for the treatment of acute DVT had, until recently, demonstrated a “one-size-fits-all” approach by recommending a single treatment-anticoagulation alone-for all variants of DVT. The latest published guidelines of the American College of Chest Physicians (ACCP) Consensus Conference on Antithrombotic and Thrombolytic Therapy include recommendations that depart significantly from previous versions (1). In the guideline, authors recognized the link between extensive venous thrombosis and severe long-term postthrombotic morbidity and acknowledged the existing evidence supporting a strategy of thrombus removal using treatment techniques that include contemporary venous thrombectomy, catheter-directed thrombolysis, and pharmacomechanical thrombolysis.
What Makes a Lesion Complex in Venous Interventions? The departure from anticoagulation alone to adopt a strategy of thrombus removal is what makes this approach complex. It is basically the physician’s misunderstanding of the pathophysiology of postthrombotic venous disease that leads to its severe morbidity. Physicians often fail to recognize that luminal venous obstruction resulting from persistent residual thrombus is the major contributor to ambulatory venous hypertension, and hence the clinical morbidity of chronic venous disease. This obstruction can be efficiently eliminated early during the phase of acute DVT; however, recanalization of the chronically occluded venous system is not associated with the same ease of treatment or the same degree of success.
