Semin intervent Radiol 2022; 39(05): 459-463
DOI: 10.1055/s-0042-1757935
Review Article

Endovascular Management of Acute Iliofemoral Deep Vein Thrombosis

Michael H. Huang
1   Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Elana T. Benishay
1   Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Kush R. Desai
1   Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations

Abstract

Lower extremity deep vein thrombosis (DVT) is frequently encountered in clinical practice. Postthrombotic syndrome (PTS) is a common sequela of DVT and encompasses a wide variety of symptoms, including severe pain, edema, and ulceration, all of which may contribute to a negative impact on quality of life. Studies have demonstrated that acute thrombosis of the iliofemoral venous segment is correlated with high rates of PTS, increased severity of symptoms, and high rates of thrombus recurrence, despite patients receiving treatment with standard-of-care anticoagulation therapy. Endovascular interventions, including catheter-directed thrombolysis, pharmacomechanical thrombectomy, and mechanical thrombectomy, have generated significant interest as a method for reduction of short-term symptom severity and potential reduction of downstream PTS severity. While there is high-quality evidence evaluating the role of catheter-directed and pharmacomechanical thrombectomy for acute iliofemoral DVT, newer mechanical-only devices that utilize thrombectomy without fibrinolytic medication are less studied. Currently, there are limited data evaluating the efficacy and safety of these treatment modalities, although investigations are ongoing.



Publication History

Article published online:
20 December 2022

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  • References

  • 1 Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton III LJ. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158 (06) 585-593
  • 2 Kahn SR, Shrier I, Julian JA. et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008; 149 (10) 698-707
  • 3 Prandoni P, Lensing AW, Cogo A. et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125 (01) 1-7
  • 4 Nathan AS, Giri J. Reexamining the open-vein hypothesis for acute deep venous thrombosis. Circulation 2019; 139 (09) 1174-1176
  • 5 Kahn SR, Shbaklo H, Lamping DL. et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost 2008; 6 (07) 1105-1112
  • 6 MacDougall DA, Feliu AL, Boccuzzi SJ, Lin J. Economic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndrome. Am J Health Syst Pharm 2006; 63 (20, Suppl 6): S5-S15
  • 7 Caprini JA, Botteman MF, Stephens JM. et al. Economic burden of long-term complications of deep vein thrombosis after total hip replacement surgery in the United States. Value Health 2003; 6 (01) 59-74
  • 8 Bergan JJ, Schmid-Schönbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med 2006; 355 (05) 488-498
  • 9 Liu D, Peterson E, Dooner J. et al; Interdisciplinary Expert Panel on Iliofemoral Deep Vein Thrombosis (InterEPID). Diagnosis and management of iliofemoral deep vein thrombosis: clinical practice guideline. CMAJ 2015; 187 (17) 1288-1296
  • 10 Vedantham S, Thorpe PE, Cardella JF. et al; CIRSE and SIR 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 2009; 20 (7, Suppl): S227-S239
  • 11 Akesson H, Brudin L, Dahlström JA, Eklöf B, Ohlin P, Plate G. Venous function assessed during a 5 year period after acute ilio-femoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg 1990; 4 (01) 43-48
  • 12 Delis KT, Bountouroglou D, Mansfield AO. Venous claudication in iliofemoral thrombosis: long-term effects on venous hemodynamics, clinical status, and quality of life. Ann Surg 2004; 239 (01) 118-126
  • 13 O'Donnell Jr TF, Browse NL, Burnand KG, Thomas ML. The socioeconomic effects of an iliofemoral venous thrombosis. J Surg Res 1977; 22 (05) 483-488
  • 14 Douketis JD, Crowther MA, Foster GA, Ginsberg JS. Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis?. Am J Med 2001; 110 (07) 515-519
  • 15 Aday AW, Beckman JA. The open vein hypothesis and postthrombotic syndrome: not dead yet. Circulation 2021; 143 (12) 1239-1241
  • 16 Haig Y, Enden T, Grøtta O. et al; CaVenT Study Group. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol 2016; 3 (02) e64-e71
  • 17 Vedantham S, Goldhaber SZ, Julian JA. et al; ATTRACT Trial Investigators. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med 2017; 377 (23) 2240-2252
  • 18 Comerota AJ, Kearon C, Gu C-S. et al; ATTRACT Trial Investigators. Endovascular thrombus removal for acute iliofemoral deep vein thrombosis. Circulation 2019; 139 (09) 1162-1173
  • 19 Kearon C, Gu CS, Julian JA. et al. Pharmacomechanical catheter-directed thrombolysis in acute femoral-popliteal deep vein thrombosis: analysis from a stratified randomized trial. Thromb Haemost 2019; 119 (04) 633-644
  • 20 Kahn SR, Julian JA, Kearon C. et al; ATTRACT Trial Investigators. Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2020; 8 (01) 8-23.e18
  • 21 Dexter DJ, Kado H, Schor J. et al; CLOUT Investigators. Interim outcomes of mechanical thrombectomy for deep vein thrombosis from the All-Comer CLOUT Registry. J Vasc Surg Venous Lymphat Disord 2022; 10 (04) 832-840.e2