Iliofemoral deep vein thrombosis can lead to post-thrombotic syndrome, a costly and morbid condition. Endovascular treatment is increasingly used for symptomatic relief, but clinical success depends on accurate patient evaluation and selection. This case describes the diagnostic and technical challenges in the care of a complex patient with post-thrombotic syndrome following stroke and extensive deep vein thrombosis. It highlights the multi-disciplinary work-up for a patient with post-thrombotic syndrome presenting with confounding symptoms, as well as the importance of considering alternative access for successful lower extremity venous recanalization.
MacDougallDAFeliuALBoccuzziSJLinJ. Economic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndrome. Am J Heal Pharm. 2006;63(20):S5–S15.
2.
KahnSR. The post-thrombotic syndrome. Hematology. 2016;2016(1):413–418.
3.
NeglénPHollisKCOlivierJRajuS.Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg. 2007;46(5):979–990.
4.
RajuS. Best management options for chronic iliac vein stenosis and occlusion. J Vasc Surg. 2013;57(4):1163–1169.
5.
KahnSRShapiroSWellsPS, et al.Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet. 2014;383(9920):880–888.
6.
BurgstallerJMSteurerJHeldUAmann-VestiB.Efficacy of compression stockings in preventing post-thrombotic syndrome in patients with deep venous thrombosis: a systematic review and metaanalysis. Vasa. 2016;45(2):141–147.
7.
EndenTHaigYKløwNE, 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):31–38.
8.
RazaviMKJaffMRMillerLE. Safety and effectiveness of stent placement for iliofemoral venous outflow obstruction: systematic review and meta-analysis. Circ Cardiovasc Interv. 2015;8(10):e002772.
9.
WilliamsZFDillavouED. A systematic review of venous stents for iliac and venacaval occlusive disease. J Vasc Surg Venous Lymphat Disord. 2020;8(1):145–153.
10.
FalcozMTFalvoNAho-GléléS, et al.Endovascular stent placement for chronic post-thrombotic symptomatic ilio-femoral venous obstructive lesions: a singlecenter study of safety, efficacy and quality-of-life improvement. Quant Imaging Med Surg. 2016;6(4):342–352.
11.
VedanthamSKahnSRGoldhaberSZ, et al.Endovascular therapy for advanced post-thrombotic syndrome: proceedings from a multidisciplinary consensus panel. Vasc Med (United Kingdom). 2016;21(4):400–407.
12.
RajuSNeglénP. Percutaneous recanalization of total occlusions of the iliac vein. J Vasc Surg. 2009;50(2):360–368.
13.
ChaitJAlsheekhAAurshinaA, et al.Effect of venous access site on postintervention stent thrombosis for nonthrombotic iliac vein stenting. J Vasc Surg Venous Lymphat Disord. 2020;8(1):84–88.
14.
YeKLuXJiangM, et al.Technical details and clinical outcomes of transpopliteal venous stent placement for postthrombotic chronic total occlusion of the iliofemoral vein. J Vasc Interv Radiol. 2014;25(6):925–932.
NayakLHildeboltCFVedanthamS.Postthrombotic syndrome: feasibility of a strategy of imaging-guided endovascular intervention. J Vasc Interv Radiol. 2012;23(9):1165–1173.
17.
LeeTYSungCSChuYCLiouJTLuiPW. Incidence and risk factors of guidewire-induced arrhythmia during internal jugular venous catheterization: comparison of marked and plain J-wires. J Clin Anesth. 1996;8(5):348–351.
18.
StuartRKShikoraSAAkermanP, et al.Incidence of arrhythmia with central venous catheter insertion and exchange. J Parenter Enter Nutr. 1990;14(2):152–155.
19.
Al-OmariMHAljarrahQMFataftahJGhoshehBManasaraZ.Endovascular management of May-Thurner syndrome in a patient with left-sided superior vena cava: a case report. Am J Case Rep. 2019;20:713–718.
