Endovascular Treatment of Chronic Occlusive Iliocaval Venous Disease in the Context of Acute Deep Vein Thrombosis

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3: The patient was a 54 year old who presented with low back pain, worsening left leg pain and swelling with a cyanosed and colder foot.On Doppler ultrasound there was monophasic arterial flow in the left leg.After exclusion of arterial embolism, the first therapeutic approach was CDT, but it was stopped because of very low fibrinogen levels and ineffective thrombus lysis on venography.After implantation of a retrievable IVC filter, surgical thrombectomy via the femoral vein was performed, with successful thrombus removal.Venography showed Cockett syndrome and a stent was implanted.At six months the patient had no major symptoms, and Doppler confirmed stent patency with no-residual obstruction or venous insufficiency.Conclusion: Awareness and timely diagnosis of PC is necessary to ensure prompt intervention to prevent loss of limb.When CDT is not effective, surgical thrombectomy is a potential alternative.Nowadays in the operating room, the availability of digital subtraction angiography can improve the thrombectomy success rate, with the results of thrombectomy and outflow assessed simultaneously, allowing treatment of iliac vein compression with stent placement, improving clinical efficacy of the procedure.Although venography assessment is the tool mostly used in the authors' department in such cases, it is not as accurate as intravascular ultrasound (IVUS), the gold standard in such procedures.Endovascular thrombectomy devices may be a reasonable alternative to surgical thrombectomy.

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