ABSTRACT
A large body of evidence reveals that post-thrombotic syndrome (PTS) is more prevalent and severe following iliofemoral deep venous thrombosis (DVT) if treatment involves anticoagulation alone. Valvular incompetence and venous obstruction—consequences of iliofemoral DVT—are associated with the most severe post-thrombotic morbidity. The eighth American College of Chest Physicians consensus committee recognized that iliofemoral DVT was an important subset of patients deserving of added attention for a treatment strategy of thrombus removal. Much of the evidence supporting thrombolysis for the treatment of iliofemoral DVT to prevent PTS is from single-center, non-randomized studies, although a more multicenter trial showed benefits of catheter-directed thrombolysis (CDT). In the Catheter-Directed Thrombolysis in Acute Iliofemoral Vein Thrombosis trial, 209 patients were randomized to CDT plus anticoagulation or anticoagulation alone. Percutaneous mechanical thrombectomy alone is less successful than CDT, and is associated with unacceptably high pulmonary embolic complications.
