Neue Therapien akuter und chronischer Beckenvenen-Obstruktionen

 

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Pathophysiologie und klinische Evaluierung des postthrombotischen Syndroms Iliokavale Obstruktionen und die damit einhergehenden pathologischen Veränderungen können mittels MR- und CT-Venografie dargestellt werden. Beide Verfahren eignen sich insbesondere, zugrunde liegende Kompressionspathologien wie ein May-Thurner-Syndrom sicher zu erkennen. Da in ca. 80 % der iliofemoralen Thrombosefälle eine iliakale, hämodynamisch relevante Obstruktion zu finden ist, sollte vor einer invasiven Therapie bevorzugt eine MR-Venografie (insbesondere bei jungen Patienten) zur Diagnostik eingesetzt werden.

Endovaskuläre Therapie der akuten iliofemoralen Thrombose Während der letzten Jahre wurde insbesondere durch die pharmakomechanische und mechanische Thrombektomie eine breite und ausreichende Evidenzsituation geschaffen, um diese Verfahren in die nationalen und internationalen Leitlinien aufzunehmen. Die Leitlinien kommen zu der Aussage, dass eine frühe Thrombus-beseitigende Maßnahme bei iliofemoraler Thrombose das Auftreten eines postthrombotischen Syndroms in seiner Häufigkeit und Schwere reduzieren kann.

Therapie der chronischen Beckenvenen-Obstruktion Chronisch-venöse Obstruktionen können mit oder ohne Beteiligung der V. femoralis communis vorliegen. Diese Unterscheidung ist therapierelevant. Die erste Gruppe kann ausschließlich endovaskulär therapiert werden, bei der zweiten Gruppe ist eventuell ein Hybridverfahren notwendig.

Abstract

Deep vein thrombosis (DVT) is associated with a high cost burden for health care systems because of secondary cost intensive complications like pulmonary embolism and especially the post thrombotic syndrome (PTS). Current standard therapy of anticoagulation for DVT therapy has not changed through the years leaving patients especially with iliofemoral vein thrombus on a high-risk situation for developing PTS. For patients with chronic venous outflow obstruction of the iliac vein system dedicated venous stents and recanalization techniques are today available.

Publication History

Article published online:
30 May 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
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