Iliofemoral venous thrombosis

A, Ascending phlebography in a patient with post-thrombotic chronic venous disease was interpreted as “no evidence of obstruction” and the result of an impedance plethysmography was normal. B, Results of a classic Linton procedure revealed considerable luminal obstruction of the femoral vein, which neither phlebography nor hemodynamic measurements diagnosed accurately. Adapted from Comerota et al.⁷ Permission requested.

Extensive deep vein thrombosis is demonstrated phlebographically in a patient 2 days after exploratory laparotomy. Clot was found extending from his calf veins to the proximal common iliac vein. Adapted from Comerota et al.⁷ Permission requested.

A, Trellis catheter (Bachus Vascular, Santa Clara, Calif) (arrows) in the iliofemoral venous segment, accessed through the popliteal vein. B, Lysus catheter (EKOS Corporation, Bothell, Wash; arrow) in the tibial-popliteal venous segment, accessed through the posterior tibial vein at the ankle. Adapted from Comerota et al.⁷² With permission.

Completion phlebogram after pharmacomechanical thrombolysis demonstrates a patent venous system from the calf veins to the vena cava. At 16 months’ follow-up, the patient had no post-thrombotic symptoms, a patent venous system, and normally functional venous valves. Adapted from Comerota et al.⁷² With permission.

Algorithm illustrates our current treatment protocol for patients with iliofemoral deep venous thrombosis (DVT). CT, Computed tomography; CD, catheter directed; PM, pharmacomechanical. Trellis catheter, Bachus Vascular, Santa Clara, Calif. Reprinted from Comerota et al.⁷ Permission requested.