Any overview of the treatment of venous disease should begin with a brief examination of its history. The first documented record of the treatment of venous disease comes to us from the writing on the treatment of varicose veins found in the Ebers papyrus circa 1500 BC.1 In the 2 millennia since the first description of vascular ligation from the Alexandrian School of Medicine in Egypt, circa 270 BC, knowledge of venous disease has seen steady advancement carried forward by the work of Leonardo DaVinci, William Harvey, Virchow, and Trendelenburg. From the first rudimentary attempts at venous thrombectomy in the early 1920s to the evolution of percutaneous and mechanical thrombectomy and endovascular stents in the 21st century to treat complex venous disease, there also exists a shared evolutionary pathway between knowledge of the disease and its treatment. It is the aim of this review to provide a comprehensive summary of the state of the art of venous disease treatment at the turn of the new century.
This review seeks to examine the endovascular approach to venous thromboembolic disease with a particular emphasis on current and evolving percutaneous treatment modalities available to the vascular interventionist and the evidence that currently exists substantiating their use.
Catheter-directed thrombolysis (CDT) has become a pivotal adjunctive therapy in the management of both acute and chronic thromboembolic venous disease. Direct infusion of the thrombolytic agent via specially designed, fenestrated catheters results in its effective delivery and leads to high local levels of drug within the thrombosed segment, thus increasing the likelihood of clot resolution and restoring vessel patency. This therapy is most likely to be successful when thrombus is acute (<14 days old) and much less effective when the clot is chronic (>4 weeks old).2 Such accelerated pharmacological thrombolysis may be performed even with …