Deep Vein Obstruction

May Thurner Syndrome in a patient with left leg swelling, increased leg size when compared to the other side.
Classic May-Thurners Disease (compression of the left common iliac vein by the iliac artery)

Compression VS, DVT

Traditionally deep vein obstruction is considered a thrombus or clot.  Through further education, awareness and advanced imaging techniques we have determined that people can have a deep venous obstruction without having a DVT. Common symptoms are one leg much bigger or swollen than the other. Large perforators especially on the lateral side of the calf and ankle. Large intramuscular vein in the calf (soleal and gastrocnemius), even having intramuscular varicose veins.  All of these symptoms should raise suspicion to an obstruction above. 

 

DVT

Conventional therapy for ilio-femoral deep vein thrombosis (DVT) is systemic heparinization followed by oral anticoagulants (warfarin) or NOAC drugs like Xerelto. Case review has reported disappointing results with systemic heparinization. Conventional therapy does not improve the situation in a timely manner, the lack of rapid resolution of symptoms or recanalization of long venous occlusions and has been associated with long-term disability secondary to chronic venous problems.  It is estimated that only 6% of patients with acute proximal DVT show complete removal or lysis of the thrombus within 10 days. Studies have shown that approximately 95% of patients with iliofemoral DVT treated with anticoagulation alone had severely compromised muscle pump function and valvular competency at 5 years of follow-up, despite improvement in venous outflow.

Newer advanced techniques allow for the surgeon to use catheter and regional lytic therapy allows a higher concentration of the lytic agency to be introduced directly into the clot, resulting in a more rapid dissolution of the thrombus. This reduces hemorrhagic complications compared than with systemic lysis. The advancements drastically improve the quality of life of the patient. There is not enough evidence, however iliac stenting and modern techniques should also have an positive economic impact in this area.