Seminars in Interventional Radiology最新文献

Venous thromboembolic events increase the risk of chronic morbidity as well as acute mortality. While the incidence of thrombotic disorders is low, intrinsic as well as transient patient risk factors can lead to increased risk of events. Preventive strategies can reduce these risks, but also expose patients to bleeding and other complications. Therefore, preventive strategies should balance the reduction in thrombotic risks with increased bleeding risks. This study will review factors that influence thrombotic risks, medical thromboprophylaxis strategies, and the use of IVC filters to prevent pulmonary emboli.

[This corrects the article DOI: 10.1055/s-0045-1809957.].

[This corrects the article DOI: 10.1055/s-0045-1809995.].

Venous thromboembolic disease (VTE) is a major cause of morbidity and mortality worldwide, consisting of both deep vein thrombosis (DVT) and pulmonary embolism (PE). Therapeutic anticoagulation is the primary treatment for acute VTE with the therapeutic goals of reducing proximal DVT embolization, inhibiting propagation or formation of new or recurrent VTE, and reducing mortality in patients with PE. Direct oral anticoagulants (DOACs) are now considered first-line therapy for most patients with acute VTE, though parenteral therapy and vitamin K antagonist (VKAs) remain as the preferred option in select patient groups. This study practically summarizes the medical management of acute VTE for interventionalists, focusing on the choice of agent amongst common pharmacologic therapies as well as the optimal duration of therapy based on risk factors for recurrent VTE.

Inferior vena cava thrombosis (IVCT) is a rare but severe form of venous thromboembolism, associated with significant risks of pulmonary embolism and post-thrombotic syndrome. While anticoagulation remains the primary treatment, acute caval thrombectomy has emerged as an effective strategy for rapid thrombus resolution in select cases. This review examines the tools, techniques, and outcomes of endovascular interventions, including aspiration and mechanical thrombectomy devices as well as catheter-directed thrombolysis and adjunctive technologies such as intravascular ultrasound and temporary IVC filters. Published retrospective studies show technical success rates of 80 to 100% and vessel patency of 75 to 90% at 6 to 12 months, with low complication rates. Despite promising results, prospective studies are needed to standardize device selection and post-procedural care. This review highlights thrombectomy's role as a first-line option for IVCT, offering rapid, lytic-free clot removal.

Large-bore thrombectomy has emerged as a critical treatment option in the management of iliocaval thrombosis, a condition associated with high morbidity and mortality. These devices are designed for rapid removal of clot and symptom resolution while minimizing the need for thrombolytic therapy. Ongoing trials, prospective registries, and retrospective reviews are also investigating the role of early thrombectomy or thrombolysis on subsequent development of post-thrombotic syndrome. These interventions are particularly beneficial for patients with contraindications to systemic or catheter-directed thrombolysis, those at high risk for post-thrombotic syndrome, or those with chronic thrombus, which is less likely to respond to lytic therapy. These devices utilize mechanical, aspiration, and rotatory systems to break up and remove acute and chronic, densely adherent thrombus. Each has unique characteristics that make them preferred in different disease states and many cases require use of multiple devices in conjunction with one another. This review describes the importance of large-bore thrombectomy in the treatment of iliocaval thromboembolic disease and highlights modern devices and case-specific uses for each.

Pregnancy considerably increases the risk of venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism. The treatment of these disorders poses unique diagnostic and therapeutic challenges, particularly in balancing maternal and fetal safety. Interventional radiology plays a critical role in the management of pregnancy-associated VTE through advanced imaging techniques and minimally invasive procedures such as catheter-directed therapy and inferior vena cava filter placement. This review explores the epidemiology, pathophysiology, and management strategies for VTE in pregnancy with special attention to interventional treatment strategies, emphasizing patient-centered care and multidisciplinary collaboration to optimize outcomes.

The role of catheter-directed therapy, in the form of pharmacologic, mechanical, or combination therapy, remains unclear in the treatment of acute pulmonary embolism. Multiple prospective randomized controlled clinical trials are ongoing in an attempt to answer this critical clinical question. This brief manuscript describes the current randomized controlled trials for this disease process.

Venous thromboembolism (VTE) remains a significant cause of morbidity and mortality in cancer patients. Although anticoagulation is the mainstay therapy, select patients may benefit from interventional radiology (IR)-guided procedures to address acute, chronic, or refractory thrombotic disease. This article outlines a comprehensive approach to managing cancer-associated VTE using a wide array of IR techniques, including inferior vena cava (IVC) filter placement, catheter-directed thrombolysis, and mechanical thrombectomy for deep venous thrombosis, pulmonary embolism, portal vein thrombosis, and tumor thrombus.