Abstract
General Considerations
Restoring patency to a thrombosed vein and preserving valve function is important to reduce the risk and severity of the postthrombotic syndrome. Long-term studies demonstrate improved patency of iliac veins following thrombectomy with anticoagulation alone.1–5 A randomized trial of iliofemoral venous thrombectomy with a temporary arteriovenous fistula versus anticoagulation demonstrated improved venous patency and improved clinical and hemodynamic outcome with preserved valve function in the thrombectomy group.3–5 Further studies comparing thrombectomy with conventional treatment are needed to determine recurrence and late outcome rates.
Recommendation
Surgical venous thrombectomy should be considered for patients with symptomatic iliofemoral DVT who are not candidates for catheter-directed thrombolysis (level of evidence: low).