chapter  11
10 Pages

Common femoral endovenectomy and endoluminal recanalization for chronic postthrombotic iliofemoral venous obstruction

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.