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SURGICAL TREATMENT OF POSTPARTUM ILIOFEMORAL DEEP VEIN THROMBOSIS--CASE REPORTS
Insights
Surgical thrombectomy effectively treats iliofemoral deep vein thrombosis (DVT), reducing long-term symptoms and improving venous function. This approach is recommended when catheter-directed thrombolysis is not feasible.
Area of Science:
- Vascular Surgery
- Thrombosis Management
- Medical Guidelines
Background:
- Current guidelines recommend thrombus removal for acute iliofemoral deep vein thrombosis (IFDVT).
- Catheter-directed thrombolysis is preferred over surgical thrombectomy due to reduced hemorrhage risk.
- Surgical thrombectomy remains a viable option when other methods are unavailable or unsuitable.
Observation:
- This case series presents three postpartum patients with IFDVT.
- All patients underwent anticoagulant therapy before surgical thrombectomy.
- Surgical intervention involved thrombectomy of multiple deep veins and an arteriovenous fistula.
Findings:
- Randomized studies indicate surgical thrombectomy improves venous permeability, reduces pressure, and alleviates post-thrombotic symptoms long-term compared to anticoagulation alone.
- Postoperative Doppler ultrasound follow-up at 3, 6, and 9 months assessed venous system patency.
Implications:
- Surgical thrombectomy is an effective treatment for IFDVT, particularly in postpartum patients.
- The procedure can lead to significant long-term improvements in venous health and symptom reduction.
- Further research may explore optimal timing and patient selection for thrombectomy in IFDVT.
Abstract:
The writing committee for Antithrombotic Therapy for Venous Thromboembolic Disease of the 2008 ACCP guidelines made the following recommendations for thrombus removal strategies in patients with deep vein thrombosis (DVT): open surgical thrombectomy is recommended in patients with acute iliofemoral DVT to reduce symptoms and post-thrombotic morbidity; whenever available, catheter-directed thrombolysis is preferred to surgical venous thrombectomy, the risk of hemorrhage being diminished; surgical venous thrombectomy is recognized to be efficient in cases where catheter-directed thrombolysis is unavailable or the patients are not suitable candidates for such a procedure. Randomized studies comparing surgical thrombectomy and anticoagulant therapy in patients with iliofemoral DVT (IFDVT) showed that at 6 months, 5 years, and 10 years the patients in the thrombectomy group presented increased permeability, lower venous pressure, less edema, and fewer postthrombotic symptoms compared to the patients receiving anticoagulant therapy. In this article we present 3 cases of IFDVT in postpartum patients diagnosed by Doppler ultrasound of the deep venous system. The 3 patients received anticoagulant therapy prior to surgery. Surgery consisted in thrombectomy of the common, superficial and deep femoral veins, external and internal iliac veins, and femoral-saphenous arteriovenous fistula. The patients received postoperative antithrombotic therapy and were followed-up at 3, 6 and 9 months by Doppler ultrasound of the deep venous system.
