Thrombolysis for iliofemoral deep venous thrombosis

Abstract

Patients with iliofemoral deep vein thrombosis (DVT) comprise a subset of patients with DVT who are at significant risk for developing the postthrombotic syndrome (PTS) following treatment with anticoagulation alone. PTS can have debilitating effects on patients’ quality of life. Its symptoms range from pain and heaviness to venous ulceration. Treatment techniques that eliminate the thrombus burden from the lower extremity have been shown to reduce the incidence of postthrombotic symptoms by restoring venous patency to the iliofemoral venous system and preserving valvular function. Treatment techniques include operative thrombectomy, catheter-directed thrombolysis and pharmacomechanical thrombolysis. This paper focuses on the latter two techniques and reviews the evidence for adopting the strategy of thrombus removal in patients with iliofemoral DVT.

Keywords::

• catheter-directed thrombolysis
• iliofemoral DVT
• pharmacomechanical thrombolysis
• postthrombotic syndrome
• thrombolytic therapy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Patients with iliofemoral deep vein thrombosis (DVT) are at exceptionally high risk for developing recurrent DVT.

• • Patients with iliofemoral DVT are at exceptionally high risk for developing postthrombotic syndrome.

• • Iliofemoral DVT patients should be offered a strategy of thrombus removal to prevent postthrombotic syndrome and improve their quality of life.

• • Pharmacomechanical thrombolysis speeds lysis, improves efficacy and reduces dose of plasminogen activators.

• • Pharmacomechanical thrombolysis does not adversely affect valve function.

• • Venous valve function is not adversely affected by pharmacomechanical techniques of thrombolysis.

• • Treating physicians should seek to remove as much thrombus as possible and restore unobstructed venous drainage to the inferior vena cava. Residual lesions in the iliac veins should be dilated and stented to provide unobstructed venous drainage.

Notes