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Abstract
The post-thrombotic syndrome (PTS) as a long-term consequence of deep vein thrombosis (DVT) is caused by a venous obstruction and/or chronic insufficiency of the deep venous system. New endovascular therapies using catheter-directed thrombolysis or percutaneous mechanical thrombectomy enable thrombus removal of the deep veins in the acute phase of DVT aiming to reduce the incidence and severity of PTS. Current available evidence derives from case series and small randomized trials, but indicates that thrombus removal might be useful in patients with proximal DVT with high risk for PTS with acute (≤14 days) symptoms (class IIb, level of evidence B). When patient is not a candidate for catheter-directed thrombolysis, surgical thrombectomy might be considered (symptoms ≤14 days). In case of severe PTS with chronic iliofemoral venous obstruction, recanalization of iliac and caval veins can correct venous outflow. Since the first report of endovascular stent angioplasty in 2000, the endovascular techniques are becoming more popular and show patency from 38% to 100% with a low incidence of complications (stent thrombosis, haematoma). Open surgery using the Palma procedure or PTFE bypass displays patency rates of 58–100% but with higher morbidity with risk of infection, thrombosis, or haematoma. Only small, non-randomized studies have been published, resulting in only weak recommendations for open and endovascular procedures (class IIb, level of evidence B).
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