Challenges in revascularization of the venous circulation: deep vein thrombosis, venous disorders, and the role of deep venous stenting

Venous thromboembolism is common and debilitating disease placing huge economic burden on healthcare systems around the world. The mainstay of therapy is anticoagulation, but an evidence base is building for the role of venous interventions such as catheter-directed thrombolysis and deep venous stenting when the supra-inguinal segment is involved and the patient is very symptomatic. Post-thrombotic syndrome is a potential sequela and can complicate up to half of acute DVT cases leading to significant disability and loss of quality of life. A number of large trials have been conducted to compare the role of percutaneous endovenous interventions against anticoagulation in acute DVT, summarized within this chapter. Obstruction to deep venous outflow and non-thrombotic iliac vein lesions such as intraluminal scarring, webs and spurs, can contribute to venous hypertension and the pathophysiology of post-thrombotic syndrome. Deep venous stenting can provide major symptom relief in cases of severe post-thrombotic syndrome and chronic venous obstruction. Strategies for deep venous stenting are discussed within this chapter including the use of imaging modalities such as intravenous ultrasound.