Contemporary Treatment of Iliofemoral Deep Vein Thrombosis

The standard treatment for acute iliofemoral venous thrombosis has been hospital admission with bedrest, leg elevation, and anticoagulation using unfractionated heparin IV and warfarin. With the recent release from the FDA of low molecular weight heparin we can anticipate a rapid embrace of this drug for ambulatory treatment. Based on level I studies from mainly Canada and Europe, low molecular weight heparin has been proven to be highly effective in the initial treatment of established deep vein thrombosis. We will argue that the long term sequels of low molecular weight heparin treatment is not known. Early and quick removal of the thrombus is indicated to avoid the late postthrombotic syndrome. We suggest that catheter-directed intrathrombus thrombolysis with or without adjunct procedures such as angioplasty and stenting should be the first line of treatment. When there are contraindications or failure of thrombolysis, thrombectomy with a temporary arteriovenous fistula is a valid alternative, with both interventions followed by anticoagulation.