Systemic anticoagulation with
heparin or its unfractionated derivatives followed by
warfarin therapy has been the mainstay of treatment in patients with lower extremity
deep venous thrombosis (DVT). Although
heparin is an effective treatment modality in preventing
thrombus propagation, it provides minimal
therapeutic effect in dissolving preexisting venous
thrombus. The clinical consequence of DVT, owing in part to loss of venous endothelial and valvular function, is
postphlebitic syndrome or chronic
venous insufficiency. Current advances in endovascular
therapy have resulted in various endovascular
thrombectomy systems that can effectively remove a large venous
thrombus burden, which may represent a potential advantage of preserving venous valvular function and thereby reduce the likelihood of
postphlebitic syndrome. In this article, we review a variety of surgical and interventional methods in venous
thrombus removal. Current treatment modalities using mechanical
thrombectomy devices and pharmacomechancial
thrombectomy strategy are also discussed.