经导管溶栓或药物机械溶栓
几项指南建议，对于严格选择的髂股静脉急性血栓形成且出血风险低的患者，可以采用经导管溶栓(CDT)和/或药物溶栓加机械去除血栓。[97]Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(suppl):e419S-e494S.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278049/http://www.ncbi.nlm.nih.gov/pubmed/22315268?tool=bestpractice.com[112]Vedantham S, Millward SF, Cardella JF, et al. Society of Interventional Radiology position statement: treatment of acute iliofemoral deep vein thrombosis with use of adjunctive catheter-directed intrathrombus thrombolysis. J Vasc Interv Radiol. 2009;20(7 suppl):S332-S335.http://www.ncbi.nlm.nih.gov/pubmed/19560020?tool=bestpractice.com[113]Vedantham S, Sista AK, Klein SJ, et al; Society of Interventional Radiology and Cardiovascular and Interventional Radiological Society of Europe Standards of Practice Committees. Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol. 2014;25:1317-1325.http://www.jvir.org/article/S1051-0443(14)00454-0/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/25000825?tool=bestpractice.com[114]Gogalniceanu P, Johnston CJ, Khalid U, et al. Indications for thrombolysis in deep venous thrombosis. Eur J Vasc Endovasc Surg. 2009;38:192-198.http://www.ncbi.nlm.nih.gov/pubmed/19427243?tool=bestpractice.com美国胸科医师学会建议，对于经过选择的出现髂股静脉广泛近端血栓形成的患者，可能从CDT或药物机械的经导管直接去除血栓中获益，只要有合适的专家以及在使用溶栓药物情况下出血风险低。[115]Kearon C, Julian JA, Kovacs MJ, et al. Influence of thrombophilia on risk of recurrent venous thromboembolism while on warfarin: results from a randomized trial. Blood. 2008;112:4432-4436.http://bloodjournal.hematologylibrary.org/cgi/content/full/112/12/4432http://www.ncbi.nlm.nih.gov/pubmed/18791166?tool=bestpractice.com多中心研究，ATTRACT，正在进行中，它旨在评估该种治疗能否降低血栓后综合征的发病率，以及能否提高生活质量。[116]Vedantham S. Deep venous thrombosis: the opportunity at hand. AJR Am J Roentgenol. 2009;193:922-927.http://www.ajronline.org/cgi/content/full/193/4/922http://www.ncbi.nlm.nih.gov/pubmed/19770312?tool=bestpractice.com[117]Comerota AJ. The ATTRACT trial: rationale for early intervention for iliofemoral DVT. Perspect Vasc Surg Endovasc Ther. 2009;21:221-224.http://www.ncbi.nlm.nih.gov/pubmed/20047905?tool=bestpractice.com
