ABSTRACT
Natural history studies of anticoagulation for iliofemoral deep venous thrombosis (DVT) treated with anticoagulation alone have shown that, at 5 years, over 90% of patients have venous insufficiency, 15% have experienced venous ulceration, and up to 50% have compromised ambulation as a result of the discomfort of ambulatory venous hypertension.1,2 Patients with chronic postthrombotic iliofemoral venous obstruction have a significantly reduced quality of life, which could have been avoided if their acute DVT had been treated with a strategy of thrombus removal.3 A prospective observational study has shown that iliofemoral DVT patients have the most severe postthrombotic morbidity.4 Unfortunately, most patients are treated with anticoagulation alone rather than a strategy of thrombus removal, as many physicians fail to appreciate the connection between iliofemoral venous obstruction and the subsequent severity of postthrombotic morbidity.
