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Acute lower limb DVT 

Acute lower limb DVT
Chapter:
Acute lower limb DVT
Author(s):

Anthony J. Comerota

and Vijay Kamath

DOI:
10.1093/med/9780199658220.003.0070
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date: 19 September 2019

Treatment goals of deep venous thrombosis (DVT) of the lower extremity are to avoid venous hypertension and restore haemodynamics. Appropriate treatment depends upon the anatomic distribution, extent of thrombus, and degree of luminal obstruction. Acute obstruction of the single channel outflow from the lower extremity leads to high compartment and venous pressures which, if undertreated, can produce severe venous hypertension and debilitating symptoms of post-thrombotic syndrome. Anticoagulation remains the mainstay of treatment for acute DVT, but many patients fail to be adequately anticoagulated both early on and over the long term, which may result in chronic post-thrombotic morbidity and significant risk of recurrence. Moreover, patients with iliofemoral DVT should be offered a strategy of thrombus removal in addition to therapeutic anticoagulation, as the severity of post-thrombotic venous disease correlates directly with the extent of the acute DVT. Thrombus removal techniques include operative venous thrombectomy, catheter-directed thrombolysis, and pharmacomechanical thrombolysis.

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