REVIEW  ENDOVENOUS TREATMENT STRATEGIES FOR ILIOFEMORAL DVT Free access

The Journal of Cardiovascular Surgery 2024 February;65(1):42-8

DOI: 10.23736/S0021-9509.23.12926-0

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Randomized controlled trials of interventions for acute iliofemoral deep venous thrombosis

Benedict R. TURNER ¹, Adam M. GWOZDZ ^{1, 2}, Alun H. DAVIES ¹, Stephen A. BLACK ² ✉

¹ Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; ² Academic Department of Vascular Surgery, St Thomas’ Hospital, King’s College London, London, UK

Venous thromboembolism (VTE), notably deep venous thrombosis (DVT), represents a significant cardiovascular disease with high morbidity from post-thrombotic syndrome (PTS). Recent advancements in early thrombus removal technologies have prompted randomized controlled trials (RCT) to assess their efficacy and safety, particularly for iliofemoral DVT (IF-DVT), which carries the greatest risk of developing PTS. This narrative review summarizes these trials and introduces upcoming innovations to evaluate acute intervention for IF-DVT. Specific technologies discussed include catheter-directed thrombolysis, pharmacomechanical catheter-directed thrombolysis, ultrasound-accelerated catheter-directed thrombolysis, and non-lytic mechanical thrombectomy. This review underscores the importance of patient selection, with those presenting with extensive, symptomatic IF-DVT likely to benefit most.

KEY WORDS: Venous thrombosis; Postthrombotic syndrome; Thrombolytic therapy