Abstract

Deep vein thrombosis (DVT) is an important cause of short-term mortality and long-term morbidity. Among the different presentations of DVT, thrombus in the iliofemoral veins may be considered the severest form. Although anticoagulation is the mainstay of the management of iliofemoral thrombosis, despite adequate anticoagulant treatment, complications including post-thrombotic syndrome is not uncommon. The latter is often overlooked but can cause considerable morbidity to the affected individuals. Preventing this condition remains a challenge but recent clinical trials of catheter directed thrombolysis and elasticated compression stockings provide some advance in this context. In this article, with the aid of a clinical case, we review the particular considerations to take into account when managing patients with an iliofemoral DVT.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. White RH. The Epidemiology of Venous Thromboembolic Disease Venous Thromboembolism. Circulation. 2003;107(90231):4–9.
2. Stephenson EP, Liem TK. Duplex imaging of residual venous obstruction to guide duration of therapy for lower extremity deep venous thrombosis. J Vasc Surg Venous Lymphat Disord [Internet]. 2015;3(3):326–32. Available from: http://linkinghub.elsevier.com/retrieve/pii/S2213333X14001486%5Cn http://dx.doi.org/10.1016/j.jvsv.2014.08.003
3. Prandoni P. Residual Clot in Patients with Deep Vein Thrombosis and Pulmonary Embolism: Prognostic Implications. J Hematol Thromb [Internet]. 2015;1(1):1–3. Available from: http://www.avensonline.org/fulltextarticles/jht-2380-6842-01-0004.html%5Cnhttp://www.avensonline.org/wp-content/uploads/JHT2380-6842-01-0004.pdf
4. Liu D, Peterson E, Dooner J, et al. Diagnosis and management of iliofemoral deep vein thrombosis: clinical practice guideline. Can Med Assoc J [Internet]. 2015;1–9. Available from: http://www.cmaj.ca/content/early/2015/09/28/cmaj.141614.full.pdf
5. Nyamekye I, Merker L. Management of proximal deep vein thrombosis. Phlebology. 2012;27(Supplement 2):61–72.
6. Girard P, Decousus M, Laporte S, et al. Diagnosis of Pulmonary Embolism in Patients with Proximal Deep Vein Thrombosis. Am J Respir Crit Care Med. 2001;164:1033–7.
7. Douketis JD, Crowther MA, Foster GA, et al. Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis? Am J Med. 2001;110(7):515–9.
8. Stain M, Schönauer V, Minar E, et al. The post-thrombotic syndrome: risk factors and impact on the course of thrombotic disease. J Thromb Haemost. 2005;3(12):2671–6.
9. Rabinovich A, Kahn SR. The postthrombotic syndrome: current evidence and future challenges. Vol. 15, Journal of Thrombosis and Haemostasis. 2017. p. 230–41.
10. Chinsakchai K, Ten Duis K, Moll FL, et al. Trends in Management of Phlegmasia Cerulea Dolens. Vasc Endovascular Surg.2011;45(1):5–14.
11. Chung JW, Yoon CJ, Jung S Il, et al. Acute Iliofemoral Deep Vein Thrombosis: Evaluation of Underlying Anatomic Abnormalities by Spiral CT Venography. J Vasc Interv Radiol [Internet]. 2004;15(3):249–56. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1051044307602103
12. Peters M, Syed RK, Katz M, et al. May-Thurner syndrome: a not so uncommon cause of a common condition. Proc (Bayl Univ Med Cent) [Internet]. 2012;25(3):231–3. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3377287&tool=pmcentrez&rendertype=abstract
13. Robinson D. Iliofemoral venous thrombosis. Developments in management. Med Today [Internet]. 2014;15(6):49–51. Available from: http://medicinetoday.com.au/sites/default/files/cpd/MT2014-06-049-ROBINSON.pdf
14. Vedantham S. Interventional approaches to deep vein thrombosis. TL - 87 Suppl 1. Am J Hematol [Internet]. 2012;87 Suppl 1(S1):8. Available from: http://dx.doi.org/10.1002/ajh.23145
15. Vedantham S, Piazza G, Sista AK, et al. Guidance for the use of thrombolytic therapy for the treatment of venous thromboembolism. J Thromb Thrombolysis. 2016;41(1):68–80.
16. Kahn SR. How I treat postthrombotic syndrome. Blood.2009;114(21):4624–31.
17. Pikovsky O, Rabinovich A. Prevention and treatment of the post-thrombotic syndrome. Thrombosis Research. 2017;S0049–3848(17)30410–3.
18. Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Vol. 2016, Cochrane Database of Systematic Reviews. p. 1–57.
19. Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: A scientific statement from the american heart association. Circulation. 2011;123(16):1788–830.
20. NICE. Venous thromboembolic diseases: diagnosis, management and diagnosis, management and thrombophilia testing thrombophilia testing. Clin Guidel 144 [Internet]. 2012;(June 2012).Available from: https://www.nice.org.uk/guidance/cg144/resources/venous-thromboembolic-diseases-diagnosis-management-andthrombophilia-testing-pdf-35109570835141
21. Plate G, Eklof B, Norgren L, et al. Venous thrombectomy for iliofemoral vein thrombosis - 10-year results of a prospective randomised study. Eur J Vasc Endovasc Surg. 1997;14(5):367–74.
22. Casey ET, Murad MH, Zumaeta-Garcia M, et al. Treatment of acute iliofemoral deep vein thrombosis. J Vasc Surg. 2012;55(5):1463–73.
23. Enden T, Haig Y, Kløw NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): A randomised controlled trial. Lancet. 2012;379(9810):31–8.
24. van Dongen CJJ, Prandoni P, Frulla M, et al. Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. J Thromb Haemost. 2005;3(5):939–42.
25. Mousavi S, Moradi M, Khorshidahmad T, et al. Anti-inflammatory effects of heparin and its derivatives: A systematic review. Adv Pharmacol Sci [Internet]. 2015;2015. Available from: http://www.hindawi.com/journals/aps/%5Cnhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed13&NEWS=N&
    AN=2015087483
26. Hull RD, Liang J, Townshend G. Long-term Low-MolecularWeight Heparin and the Post-Thrombotic Syndrome: A Systematic Review. AJM. 2011;124:756–65.
27. San Norberto E. Effects of rosuvastatin as an adjuvant treatment for deep vein thrombosis. Vasa. 2016;45(2):133–40.
28. Brandjes DP, Büller HR, Heijboer H et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet. 1997;349(9054):759–62.
29. Prandoni P, Lensing AW, Prins MH, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med [Internet].2004;141(4):249–56. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15313740%5Cnhttp://annals.org/article.aspx?articleid=717753
30. Kahn SR, Shapiro S, Wells PS, et al. Compression stockings to prevent post-thrombotic syndrome: A randomised placebocontrolled trial. Lancet [Internet]. 2014;383(9920):880–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24315521