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Abstract
Iliofemoral deep vein thrombosis (IFDVT) represents a clinically important subset of patients with acute DVT and identifies those who are most likely to have the most severe postthrombotic syndrome (PTS). Anticoagulation is the therapy for most with acute DVT, although those with IFDVT have benefited from strategies of thrombus removal. Current information suggests that elimination of thrombus reduces PTS by restoring patency and potentially preserving valvular function. Observational studies suggest that elimination of thrombus reduces recurrence. Retrospective studies, observational data, cohort-controlled studies and randomized trials support a strategy of thrombus removal for patients with IFDVT. The largest randomized trial to date of catheter-directed thrombolysis versus anticoagulation, the ATTRACT trial, has just completed enrollment. The primary endpoint is PTS at 2 years. Data from ATTRACT are likely to have a major impact on patient care. Until then, available information supports the use of catheter-directed thrombolysis for IFDVT.
Financial & competing interests disclosure
The author has 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.