Acute Lower Extremity Deep Venous Thrombosis: Surgical and Interventional Treatment

The underlying premise of this chapter is that patients with a large burden of thrombus occluding the single common outflow channel from their leg are at high risk of developing disabling post-thrombotic syndrome (PTS), and that adopting a management strategy of thrombus removal reduces their risk of moderate/severe PTS. The evolution of technology has improved catheter-based techniques which often integrate mechanical methods of thrombus removal with the judicious infusion of plasminogen activators which now replaces surgical thrombectomy in the majority of patients. However, just as catheter-based techniques have advanced, so have operative procedures, which integrate contemporary imaging, venous balloon dilation and stenting and adjunctive, low-dose plasminogen activators in addition to regionally delivered anticoagulation. Such modifications improve outcomes and reduce procedure-related complications. Randomized trial results often lag behind technology. We now have additional randomized trial data comparing catheter-based techniques with anticoagulation in patients with iliofemoral DVT. New trials of operative thrombectomy have not been performed since the 9th edition of this book.