A contemporary overview of the management of acute ilio-femoral deep vein thrombosis; why, how and where next?

Unprovoked acute deep vein thrombosis (DVT) is a common problem, affecting around 50 to 100 per 10000 people. 1,2A significant number of these (20%) will involve the iliac veins or inferior vena cava.The symptoms of acute DVT are well described and include, sudden onset of swelling, pain, redness and difficultly mobilising.On occasion the extent of venous congestion can be so severe it threatens the limb, a phenomenon termed phlegmasia.The cornerstone of DVT management irrespective of the location, is anticoagulation, elevation, and compression of the affected limb. 3,4These initial steps can improve acute symptoms but the rate at which symptoms resolve with these measures alone is variable.In the medium to long-term, all patients with a DVT are at risk of developing persisting symptoms such as swelling, skin changes, venous eczema, venous claudication, and ulceration; termed post-thrombotic syndrome (PTS), and occurs after approximately 50% of all DVTs. 5 These symptoms have a significant negative impact on quality of life for which there is no 'cure'.