Long-term outcome of transfemoral thrombectomy in patients with acute iliofemoral vein thrombosis

Background: The optimal therapy of acute iliofemoral venous thrombosis is still a matter of debate. The purpose of our study was to evaluate the late results of iliofemoral thrombectomy with regard to the prevention of the development of a Post Thrombotic Syndrome (PTS). Methods: During 2000-2003, 18 patients underwent transfemoral venous thrombectomy for acute iliofemoral venous thrombosis. 16 patients were reexamined after a 5-year follow-up. At follow-up, the patency of venous segments as well as the development of reflux was investigated by duplex-ultrasound. Furthermore, clinical signs and symptoms of PTS in patients were recorded. Results: Clinical pulmonary emboli did not occur in the perioperative period. Two patients died because of disseminated metastatic cancer and another after massive retroperitoneal bleeding due to anticoagulation therapy. In a 5-year follow up, 31% had valvular reflux. Venous patency rate was 75%. The rate of PTS was 37.5% without the severe form of PTS. Patients did not have healed, healing, and/or active venous ulcer. Conclusion: It is thought that vein patency and valvular function were relatively restored, and PTS was prevented after surgical thrombectomy. Vascular surgeons should include venous thrombectomy as a part of their routine operative armamentarium, offering this procedure to patients with iliofemoral DVT, especially if other options are not available or have failed.