Strategy of thrombus removal
A large body of evidence indicates that early elimination of thrombus prevents or reduces postthrombotic morbidity. This is especially true in patients with iliofemoral deep vein thrombosis (DVT). Considering that the common femoral vein, external iliac vein, and common iliac vein are a single channel responsible for the entire venous drainage from the lower extremity, occlusion of the iliofemoral system leads to severe venous hypertension at the time of the acute event1 and persistently high venous pressures chronically.2 Early removal of the thrombus from the iliofemoral system restores venous (compartment) pressures to normal1; therefore, it would be anticipated that eliminating acute outflow obstruction would substantially improve long-term results. Every randomized trial to date and essentially all comparative studies assessing the value of thrombus removal in patients with iliofemoral DVT have demonstrated benefit.