Clinical and anatomical findings of acute iliofemoral deep venous thrombosis

Abstract

Objective: To observe the clinical and anatomical features of acute iliofemoral deep venous thrombosis (DVT).

Methods: A consecutive sample of phlebographically confirmed DVT cases during a 25-month period were retrospectively assessed. There were 390 DVT cases, including 73 patients with iliofemoral DVT. The phlebograms of iliofemoral DVTs were reviewed and the location of the thrombus mapped. The patients' files were completely reviewed in all patients with DVT, including concomitant diseases and mortality after the diagnosis of DVT.

Results: The average age of the patients with iliofemoral DVT was 63 years compared with 57 years in the cases of infrainguinal DVT (P<0.005). Left : right-ratio was 2.43 in iliofemoral DVTs, and 1.42 in infrainguinal cases (P<0.005). Iliofemoral DVT cases were multisegmental (from calf into iliac veins) in 92% of the legs. The aetiology of iliofemoral DVT was idiopathic in 55%, surgery in 14%, malignancy in 14%, immobilization in 10%, trauma in 5%, coagulation disorder in 1% and pregnancy in 1% of the cases. No concomitant diseases were noted in 32% of the patients with iliofemoral DVT, and the corresponding finding in the subgroup of infrainguinal DVTs was 57%. The incidence of death within one-year was 18% and 8% in the subgroups of iliofemoral and infrainguinal DVT. In patients with a combination of iliofemoral DVT and malignancy,the incidence of death within one-year was 80%.

Conclusions: According to anatomical findings iliofemoral DVT is typically left-sided and multisegmental. However, clinical findings show that patients with this condition are relatively aged, and the frequency of concomitant diseases is high. The prognosis among the patients with pre-existing malignant disease was very poor. Prevention of post-thrombotic syndrome by using invasive treatment should be considered only in selected cases.