Thrombolysis for iliofemoral deep venous thrombosis

Patients with iliofemoral deep vein thrombosis (DVT) comprise a subset of patients with DVT who are at significant risk for developing the postthrombotic syndrome (PTS) following treatment with anticoagulation alone. PTS can have debilitating effects on patients' quality of life. Its symptoms range from pain and heaviness to venous ulceration. Treatment techniques that eliminate the thrombus burden from the lower extremity have been shown to reduce the incidence of postthrombotic symptoms by restoring venous patency to the iliofemoral venous system and preserving valvular function. Treatment techniques include operative thrombectomy, catheter-directed thrombolysis and pharmacomechanical thrombolysis. This paper focuses on the latter two techniques and reviews the evidence for adopting the strategy of thrombus removal in patients with iliofemoral DVT.