Surgical Thrombectomy for Treatment of Acute Iliofemoral Venous Thrombosis

Special Article – Vein Thrombosis Surgery

Austin J Surg. 2020; 7(1): 1242.

Surgical Thrombectomy for Treatment of Acute Iliofemoral Venous Thrombosis

Igor M Ignatyev*

Interregional Clinical and Diagnostic Center, Kazan State Medical University, Russia

*Corresponding author: Igor M. Ignatyev, Department of Vascular Surgery, Interregional Clinical and Diagnostic Center, 12 A, Karbyshev st., 420101, Kazan, Russian Federation, Russia

Received: January 20, 2020; Accepted: February 20, 2020; Published: February 27, 2020


Objective: To assess the effectiveness of open surgical thrombectomy in acute iliofemoral venous thrombosis.

Methods: Between January 2012 and October 2018, a total of 65 patients underwent transfemoral venous thrombectomy (VT) in acute iliofemoral venous thrombosis. Ten patients received a venous hybrid operation comprising ballooncatheter thrombectomy and stenting of residual stenosis of iliac vein. The control group consisted of 44 patients who received standard anticoagulant therapy. The results were evaluated by duplex ultrasound (DUS). The assessment of clinical effectiveness was made with Venous Clinical Severity Score (VCSS), Villalta Score and health-related quality of life (HRQoL).

Results: Secondary patency of iliofemoral segment at 6 months of monitoring after thrombectomy was reported in 97% of cases. Meanwhile, the recanalization of iliofemoral segment was registered only in 27% (P< .0001) of patients who had anticoagulant therapy alone. The median preoperative VCSS was 7, which dropped to 2 at 6 months (P=.002). There were five cases of successful re-thrombectomy and stenting (three cases). Cumulative primary and secondary patency rates of iliofemoral veins at 72 months were 88% and 95%, respectively. The data Villalta score in long-term follow-up in patients after surgery was significantly lower than of patients treated with anticoagulation (P<.001). HRQoL of patients after 6 years of VT was improved, its mean score decreased from 45.3 (8.6) to 23.6 (6.1; P< .001).

Conclusion: According to selective indications open surgical thrombectomy in iliofemoral venous thrombosis with using current methods of deep vein restoration patency increases the effectiveness of treatment of this severe pathology and prevents from progression of postthrombotic syndrome.

Keywords: Acute iliofemoral venous thrombosis; Open surgical thrombectomy; Stenting; Recanalization; Duplex ultrasound


Deep Venous Thrombosis (DVT) of lower extremities is one of the most widespread vascular diseases, from 160 to 300 cases per 100 000 of general population occur annually [1,2]. Symptomatic pulmonary embolism (PE) accompanies approximately 10% of DVTs and hospital discharge data suggest an incidence of 23 per 100 000 population [3].

The treatment of DVT has two main goals. During an acute period, it is a prevention of complications such as PE and phlegmasia cerulea dolens, in the long-term - minimization of postthrombotic syndrome (PTS), that is 40-60% of patients. One in ten patients has venous leg ulcer that results in disability [4,5]. The most complicated disturbances of venous hemodynamics occur when iliofemoral veins are damaged [6,7].

The traditional method of treatment of acute DVT is anticoagulant therapy that is based on unfractioned and low-molecular-weight heparins, vitamin K antagonist and direct oral anticoagulants. However, these medications have no thrombolytic effect but they prevent from thrombus prolongation, reccurence of thrombosis and they let the risk of PE development decrease [8].

Aggressive methods of DVT treatment have been developed in recent years. These include regional catheter-directed and pharmacomechanical thrombolysis. The advantage of this approach is shown in randomized trial CaVenT (Catheter-directed Venous thrombolysis in acute iliofemoral vein Thrombosis) [9]. However, data from the randomized controlled ATTRACT (Acute venous Thrombosis: Thrombus Removal with Adjunctive Catheter-directed Thrombolysis) trial revealed that the addition of catheter-based intervention to standard-of-care anticoagulation failed to significantly decrease the occurrence of postthrombotic syndrome in patients who received this treatment strategy when compared with its occurrence in patients who received anticoagulation alone [10]. Although ATTRACT has failed to meet its primary endpoints, its results will offer a springboard for ongoing research in this area. If there are any contraindications to thrombolytic therapy, it is recommended to perform open venous thrombectomy [2]. When this active strategy of DVT treatment is used, the risk of residual obstruction and venous valves damage with reflux decreases. As a result, it prevents from severe complications of PTS [11,12].

The aim of this study is to assess the effectiveness of open thrombectomy in acute iliofemoral venous thrombosis.

Materials and Methods

Between January 2012 and October 2018, a total of 65 patients underwent transfemoral venous thrombectomy (VT) in setting of acute iliofemoral venous thrombosis. 51 patients had occlusive thrombosis and 14 patients had floating thrombus on duplex ultrasound. Isolated thrombosis was registered in four cases. Iliofemoral thrombosis with total occlusions of deep veins and phlegmasia cerulea dolens was observed in one patient. Ten patients underwent a venous hybrid operation consisting of balloon-catheter thrombectomy and stenting of residual stenosis.

The patients characteristics are represented in Table 1. In the control group, there were 44 patients with iliofemoral thrombosis (18 men, 26 women, mean age is 54 (range 22-68) that received standard anticoagulant therapy alone for 6 months.