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The venous thrombectomy: obsolete or forgotten?
H Lacroix1, K Van Belle, A Nevelsteen
1Department of Vascular Surgery University Hospital Gasthuisberg Leuven, Belgium.
Insights
Surgical management of ilio-femoral deep venous thrombosis (DVT) shows varied outcomes. Stenting residual iliac vein blockages improved long-term results, suggesting endovascular techniques enhance DVT treatment.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Thrombosis Management
Background:
- Deep venous thrombosis (DVT) in the ilio-femoral region poses significant challenges.
- Effective management strategies are crucial to prevent chronic venous insufficiency.
- Surgical and endovascular interventions are considered for complex DVT cases.
Observation:
- Three patients with extended ilio-femoral DVT underwent surgical management.
- Patient 1: Conservative treatment of residual common iliac vein occlusion led to chronic venous insufficiency.
- Patient 2: Stenting of residual (sub)occlusion resulted in asymptomatic status at two-year follow-up.
- Patient 3: No residual abnormality found, with a good outcome at one year.
Findings:
- Conservative management of residual iliac vein occlusion can lead to poor long-term outcomes.
- Endovascular stenting of residual iliac vein stenosis is a viable option, offering good long-term results.
- Venous thrombectomy remains a relevant treatment modality for DVT.
Implications:
- Long-term outcomes in ilio-femoral DVT management can be improved by integrating endovascular techniques.
- Personalized treatment approaches based on residual venous obstruction are essential.
- Further research into optimizing DVT treatment protocols is warranted.
Abstract:
This report describes the surgical management of three patients with an extended ilio-femoral deep venous thrombosis. In the first patient a residual occlusion of the common iliac vein was treated conservatively and this patient developed severe chronic venous insufficiency. In the second patient a residual (sub)occlusion of the common iliac vein was treated with a stent and this patient remained asymptomatic with two years follow-up. In the third patient no residual or underlying anatomical abnormality was found with a good result at one year. Venous thrombectomy still has a place in the treatment of deep venous thrombosis and the long term results may be improved by application of endovascular techniques.