Interventions in Acute Ilio-Femoral DVT – 5 Years Institutional Experience

Interventions in acute ilio-femoral DVT: 5 years’ institutional experience

S. Visvesh¹, Nedounsejiane Mandjiny²

¹Dr NB Vascular Surgery Resident, Kauvery Hospital, Cantonment, Trichy

²Senior Consultant Vascular & Endovascular Surgeon, Kauvery Hospital, Cantonment, Trichy

Background

The Prevailing perception among medical professional, is that anticoagulation is the only treatment for DVT?

We have surgical options too,

CDT – Catheter Directed Thrombolysis
PMT – Pharmaco Mechanical Thrombectomy
Iliac vein angioplasty and stenting
IVC filter placement

Who Should Undergo Surgical Intervention and when?

Young to middle aged & fit patients
Extensive ilio femoral / caval DVT
Poor response to therapeutic anticoagulation
May Thurner Syndrome

It all should be done Less than 2 weeks.

Classical May Thurner Syndrome

M/c (Medical Cause) in young to middle aged women with acute left leg pain & swelling

Address: DVT + Narrowing

Rationale of Audit

Decrease clot burden
Relieve acute symptoms
Prevent PE
- Leading preventable cause of death
- 3 rd m/c cause of in-hospital mortality
Reduce the risk of PTS

Post Thrombotic Syndrome

Spectrum of venous disease that affects the LL.
Varicose veins, chronic debilitating pain, intractable edema, skin changes, venous ulcer
Leg cramping, pruritis, fatigue, heaviness, venous claudication, paresthesias.
50% leg thrombi resolve spontaneously.
20 to 50 % pts. from a few months to 2 years following a LL DVT d/t incomplete recanalisation.

Investigation

CT-Chest, Abdomen and Pelvis with Contrast

Pulmonary Embolism

Mid-thigh circumference

Our Intervention Data- Acute Ilio-femoral DVT

Study Period: March 2019- March 2025
Study Population: 48 / 310 (15%)

Results

Demographics – Gender

Males – 20 (42%)

Females – 28 (58%)

Age Group

Age	No. of Population
20 –30years	4 (8%)
30 – 40 years	7 (15%)
40 - 50 years	15 (31%)
50 – 60 years	14 (29%)
60 – 70 years	6 (13%)
70 – 80 years	2 (4%)

Types

Provoked – 7 (15%)
Unprovoked – 41 (85%)
Pulmonary embolism – 15 (31.25%)

Procedural Details

IVC filter placement prior to CDT – 10 (21%)
CDT + Balloon venoplasty – 11 (23%)
CDT + Iliac vein stenting – 33 (69%)
Pharmaco Mechanical Thrombectomy (PMT) – 2 (4%) (Angioget-1, Penumbra-1)
IVC filter retrieval – 7

Procedural Details

Procedural Images

May Thurner Syndrome

Before

After

Follow Up

From 2 months to 5 years
Clinical examinations & Doppler US – stent patency
IVC Filter removal after 45-60 days.

Outcomes

Positive outcomes

Technical success – 96%
95% (46 out of 48 patients) – complete recovery
- Reduction of swelling (mid-thigh & mid leg circumference)
- Reduction of pain (VAS Score)
None developed PTS in the follow up period.

Mortality

One Mortality – 2%
On table Pulmonary Embolism (2.1%)

Complications

No major bleeding (IC, GI bleed)
4% access site hematomas (2 out of 48) – Compression dressing
Stent thrombosis – 3 out of 33 (9%) – default medications

Objectives of CDT in Acute proximal DVT

Relieve symptoms
Reduce the incidence of PE
Reduce the risk of developing PTS
Prevent chronic venous insufficiency
Plays a crucial role in minimizing both short-term and long-term complications associated with DVT.

Reference

Vedantham S, Goldhaber SZ, Julian JA, Kahn SR, Jaff MR, Cohen DJ, et al. Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis. N Engl J Med. 2017 Dec 7;377(23):2240-2252.

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Interventions in Acute Ilio-Femoral DVT – 5 Years Institutional Experience