Zusammenfassung
Venöse Thrombosen zählen zu den häufigsten Gefäßerkrankungen. Unbehandelt können sie zu lebensbedrohlichen Lungenarterienembolien führen. Spätfolgen sind chronisch venöse Insuffizienz und postthrombotisches Syndrom. Die medikamentöse Antikoagulation ist derzeit die Standardtherapie, sie verhindert in erster Linie ein appositionelles Thrombuswachstum, kann aber die Entstehung eines postthrombotischen Syndroms meist nicht verhindern. Durch die Thrombusorganisation kommt es häufig zu einer partiellen Rekanalisation mit Residualstenosen und Klappenfunktionsstörung. Die systemische Thrombolyse kann bei zeitnahem Einsatz und ausreichender Konzentration eine Thrombusauflösung mit Klappenfunktionserhalt bewirken. Als Ergänzung zur konventionellen Therapie ist die lokale Katheterthrombolyse auch bei kontraindizierter systemischer Lyse in der Lage, eine Revaskularisation zu erzielen. Durch mechanische Verfahren lässt sich die Menge des benötigten Thrombolytikums weiter reduzieren. Venöse Stenosen lassen sich mittels Ballondilatation und Stentimplantation behandeln. Dieser Artikel behandelt die einzelnen perkutanen Therapieoptionen und ihren Einsatz bei der Behandlung von Thrombosen der unteren Körperhälfte.
Abstract
Venous thrombosis is one of the most common vascular diseases. Without treatment, pulmonary embolism is a potentially life-threatening complication. Long-term complications are chronic venous insufficiency and post-thrombotic syndrome. Medical anticoagulation is currently the standard therapy, since it prevents appositional thrombus growth although it usually can not prevent the development of post-thrombotic syndrome. The structure of the thrombotic material often leads to partial recanalisation with residual stenosis. Early and sufficient systemic thrombolysis with adequate concentration may achieve disintegration of the thrombus and preservation of venous valve function. Supplementary to conservative therapy, local catheter thrombolysis is possible even in cases with contraindications for a systemic thrombolysis therapy. Additional interventional techniques reduce the required concentration of the thrombolytic. Venous stenosis can be treated by balloon angioplasty and stent implantation. This article reviews the different percutaneous treatment options as well as their application and usefulness in thrombosis of the lower torso.
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Kamper, L., Krüger, K., Altenburg, A. et al. Venöse Interventionen – Teil 1: Interventionstechniken und Thrombosen der Bein- und Beckenvenen. Radiologe 49, 257–268 (2009). https://doi.org/10.1007/s00117-008-1737-3
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DOI: https://doi.org/10.1007/s00117-008-1737-3