link
Bookmarks
Lower Extremity and Iliocaval Intervention
Brandt C. Wible, MD
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Subscribe

KEY FACTS

  • Terminology

    • Preprocedure

      • Post Procedure

        • Outcomes

          TERMINOLOGY

          • Synonyms

            • May-Thurner syndrome = Cockett syndrome, iliac vein or iliocaval compression syndrome
            • Femoral vein = superficial femoral vein
          • Definitions

            • Venous thromboembolism (VTE)
              • Includes deep vein thrombosis (DVT) & pulmonary embolism (PE)
              • Significant source of morbidity & mortality
              • Occurs in 1:1,000 people yearly
            • Catheter-directed thrombolysis (CDT)
              • Delivery of fibrinolytic agent directly into thrombus via intravascular catheter
              • Allows ↑ dose of fibrinolytic into thrombus
              • ↓ fibrinolytic bypassing thrombus via collaterals
              • May ↓ total fibrinolytic dose, treatment/hospitalization time
            • Mechanical thrombectomy (MT)
              • Removal of thrombus without lytics; removes risk of lytic-related hemorrhage
              • Often involves aspiration devices
            • Pharmacomechanical thrombolysis (PMT)
              • Thrombolytic infusion + mechanical thrombus disruption
              • ↑ contact area between fibrinolytic & thrombus
              • May improve thrombolytic action, further decreasing fibrinolytic dose & treatment/hospitalization time
            • Chronic venous insufficiency (CVI)
              • Venous reflux & ambulatory venous hypertension
              • Result of damaged, incompetent valves & venous obstruction
            • DVT: Formation of blood clot(s) in deep veins (usually lower extremities), often accompanied by inflammation (thrombophlebitis)
              • Anatomic distribution
                • Iliofemoral DVT: Includes any part of iliac vein &/or common femoral vein (CFV)
                  • High incidence of recurrent hospitalizations
                  • High incidence of postthrombotic venous ulceration
                • Femoropopliteal DVT: Involvement limited to popliteal, femoral, &/or deep femoral veins
                • Calf DVT: Involves any of paired deep calf veins
                  • Peroneal, anterior, &/or posterior tibial veins
                  • Calf DVT does not include popliteal vein
              • Duration of positive DVT symptoms/imaging tests
                • Acute DVT: < 14 days duration
                • Subacute DVT: 15-28 days duration
                • Chronic DVT: > 28 days duration
              • DVT involves left leg 3-5x more than right
                • Likely due to May-Thurner anatomy/syndrome
              • More severe initial symptoms with iliofemoral compression/occlusion than with more distal DVT
                • Much greater likelihood of developing postthrombotic syndrome (PTS)
              • Responsible for > 250,000 hospitalizations in USA/year
              • Risk factors: Acute medical illness, antiphospholipid syndrome, active cancer, inherited thrombophilia, later age, long-distance travel, major trauma, obesity, oral contraceptives/hormone replacement therapy, paralytic stroke or immobilization, pregnancy, previous VTE, recent surgery, varicose veins
            • Postthrombotic syndrome (PTS): Late DVT sequela
              • 20-40% of 1st-time, acute, iliofemoral DVT develop PTS within 2 years
                • 5-10% develop severe PTS
                • Recurrent ipsilateral DVT associated with 2-6x ↑ risk of PTS
              • Result of chronic venous hypertension
                • Due to valvular reflux & venous obstruction
                  • Post-DVT valvular damage leads to reflux
                  • Thrombosed veins impair venous return
              • Severity: Villalta scale of PTS
                • Scoring with rating for each sign/symptom of 0 (none), 1 (mild), 2 (moderate), 3 (severe)
                  • < 5 = no PTS, 5-14 = mild/moderate PTS, ≥ 15 = severe PTS
                • Patient symptoms
                  • Pain (at rest or with ambulation), cramping, heaviness, itching, numbness
                • Clinical signs
                  • Redness, hyperpigmentation, skin induration, venous ectasia, pretibial edema
                • Additional signs/symptoms
                  • Venous claudication, skin lipodermatosclerosis & ulceration, worsening of symptoms with upright position/activity
            • May-Thurner anatomy: Incidental finding; no associated DVT
              • Left iliac vein compressed obliquely & anteriorly by right iliac artery
                • Right iliac artery compresses vein against spine
                • Occurs near iliac venous confluence into inferior vena cava (IVC)
              • Very common finding
                • Incidence: Female (41%) > male (27%)
                • Rarely symptomatic
            • May-Thurner syndrome: Symptomatic finding; DVT present
              • Left iliac vein compressed obliquely & anteriorly by right iliac artery
                • Right iliac artery compresses vein against spine
                • Occurs near iliac venous confluence into IVC
                • Produces endoluminal fibrous venous scar
                  • Well seen by intravascular US (IVUS)
                  • Termed venous "spur" by surgeons & pathologists
            • Phlegmasia alba dolens: Massive venous thrombosis-associated lower extremity swelling without cyanosis
            • Phlegmasia cerulea dolens: Massive venous thrombosis-associated lower extremity swelling with limb-threatening cyanosis of lower extremity
            • Proximal/distal thrombus: Society for Vascular Surgery (SVS) recommends use of precise anatomic terminology (e.g., iliofemoral, femoropopliteal, calf) instead of describing thrombus as proximal/distal
              • Report with/without extension into IVC

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  • Society Guidelines

                    PROCEDURE

                    • Procedure-Specific Goals

                      • Patient Position/Location

                        • Procedure Steps

                          • Findings and Reporting

                            • Alternative Procedures/Therapies

                              POST PROCEDURE

                              • Things to Do

                                OUTCOMES

                                • Problems

                                  • Complications

                                    • Expected Outcomes

                                      Selected References

                                      1. Kutsenko O et al: Iliac vein stenosis: is the data strong enough for stenting in the young pelvic venous disorders (PeVD) population? Tech Vasc Interv Radiol. 24(1):100733, 2021
                                      2. Robertson B et al: Technical success and short-term results from mechanical thrombectomy for lower extremity iliofemoral deep vein thrombosis using a computer aided mechanical aspiration thrombectomy device. J Vasc Surg Venous Lymphat Disord. ePub, 2021
                                      3. Shah NG et al: Management of inferior vena cava thrombosis with the FlowTriever and ClotTriever systems. J Vasc Surg Venous Lymphat Disord. 9(3):615-20, 2021
                                      4. Stevens SM et al: Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 160(6):e545-608, 2021
                                      5. Vedantham S et al: Clinical outcomes of a pharmacomechanical catheter-directed venous thrombolysis strategy that included rheolytic thrombectomy in a multicenter randomized trial. J Vasc Interv Radiol. 32(9):1296-1309.e7, 2021
                                      6. Benarroch-Gampel J et al: Technical success and short-term outcomes after treatment of lower extremity deep vein thrombosis with the ClotTriever system: a preliminary experience. J Vasc Surg Venous Lymphat Disord. 8(2):174-81, 2020
                                      7. Kahn SR et al: Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 8(1):8-23.e18, 2020
                                      8. Masuda E et al: The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology. J Vasc Surg Venous Lymphat Disord. 8(4):505-525.e4, 2020
                                      9. Expert Panel on Interventional Radiology: ACR Appropriateness Criteria® radiologic management of venous thromboembolism-inferior vena cava filters. J Am Coll Radiol. 16(5S):S214-26, 2019
                                      10. Magnuson EA et al: Cost-effectiveness of pharmacomechanical catheter-directed thrombolysis versus standard anticoagulation in patients with proximal deep vein thrombosis: results from the ATTRACT trial. Circ Cardiovasc Qual Outcomes. 12(10):e005659, 2019
                                      11. Chick JFB et al: Endovascular iliocaval reconstruction for chronic iliocaval thrombosis: the data, where we are, and how it is done. Tech Vasc Interv Radiol. 21(2):92-104, 2018
                                      12. Shamimi-Noori SM et al: Venous stents: current status and future directions. Tech Vasc Interv Radiol. 21(2):113-6, 2018
                                      13. Tritschler T et al: Venous thromboembolism: advances in diagnosis and treatment. JAMA. 320(15):1583-94, 2018
                                      14. Mousa AY et al: Catheter-directed thrombolysis versus full anticoagulation alone in treating proximal iliofemoral deep venous thrombosis. Vascular. 25(1):111-2, 2017
                                      15. Kearon C et al: Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 149(2):315-52, 2016
                                      16. Birn J et al: May-Thurner syndrome and other obstructive iliac vein lesions: meaning, myth, and mystery. Vasc Med. 20(1):74-83, 2015
                                      17. Comerota AJ: Catheter-directed thrombolysis for iliofemoral deep vein thrombosis: helpful or hurtful? Expert Rev Hematol. 8(2):131-3, 2015
                                      18. Du GC et al: Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis. Vasa. 44(3):195-202, 2015
                                      19. Vedantham S: Interventional therapy for venous thromboembolism. J Thromb Haemost. 13 Suppl 1:S245-51, 2015
                                      20. Kahn SR et al: Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet. 383(9920):880-8, 2014
                                      21. Enden T et al: Health-related quality of life after catheter-directed thrombolysis for deep vein thrombosis: secondary outcomes of the randomised, non-blinded, parallel-group CaVenT study. BMJ Open. 3(8):e002984, 2013
                                      22. Vedantham S et al: Rationale and design of the ATTRACT study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J. 165(4):523-530.e3, 2013
                                      23. Enden T et al: Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet. 379(9810):31-8, 2012
                                      24. Kearon C et al: Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 141(2 Suppl):e419S-94S, 2012
                                      25. Meissner MH et al: Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 55(5):1449-62, 2012
                                      26. Broholm R et al: Acute iliofemoral venous thrombosis in patients with atresia of the inferior vena cava can be treated successfully with catheter-directed thrombolysis. J Vasc Interv Radiol. 22(6):801-5, 2011
                                      27. Chinsakchai K et al: Trends in management of phlegmasia cerulea dolens. Vasc Endovascular Surg. 45(1):5-14, 2011
                                      28. Jaff MR et al: Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 123(16):1788-830, 2011
                                      29. Karthikesalingam A et al: A systematic review of percutaneous mechanical thrombectomy in the treatment of deep venous thrombosis. Eur J Vasc Endovasc Surg. 41(4):554-65, 2011
                                      30. Khan IR et al: Simultaneous arterial and venous ultrasound-assisted thrombolysis for phlegmasia cerulea dolens. Ann Vasc Surg. 25(5):696, 2011
                                      31. Maleti O et al: Reconstructive surgery for deep vein reflux in the lower limbs: techniques, results and indications. Eur J Vasc Endovasc Surg. 41(6):837-48, 2011
                                      32. Popuri RK et al: The role of thrombolysis in the clinical management of deep vein thrombosis. Arterioscler Thromb Vasc Biol. 31(3):479-84, 2011
                                      33. Sarlon G et al: Congenital anomalies of inferior vena cava in young patients with iliac deep venous thrombosis. Ann Vasc Surg. 25(2):265, 2011
                                      34. Donati F et al: An uncommon clinical condition: chronic thrombosis of the inferior vena cava. A case report and review of literature. Monaldi Arch Chest Dis. 74(1):36-9, 2010
                                      35. Golarz SR et al: Use of Wall stent to exclude a thrombosed inferior vena cava filter. Ann Vasc Surg. 24(5):690, 2010
                                      36. Suwanabol PA et al: Syndromes associated with the deep veins: phlegmasia cerulea dolens, May-Thurner syndrome, and nutcracker syndrome. Perspect Vasc Surg Endovasc Ther. 22(4):223-30, 2010
                                      37. Muranishi H et al: Thrombo-occlusion of inferior vena cava filter in a patient with polycythemia vera. J Cardiol. 54(2):307-10, 2009
                                      38. Wicky ST: Acute deep vein thrombosis and thrombolysis. Tech Vasc Interv Radiol. 12(2):148-53, 2009
                                      39. Protack CD et al: Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement. J Vasc Surg. 45(5):992-7; discussion 997, 2007
                                      40. Forauer AR et al: Intravascular ultrasound in the diagnosis and treatment of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 13(5):523-7, 2002
                                      Related Anatomy
                                      Loading...
                                      Related Differential Diagnoses
                                      Loading...
                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Preprocedure

                                          • Post Procedure

                                            • Outcomes

                                              TERMINOLOGY

                                              • Synonyms

                                                • May-Thurner syndrome = Cockett syndrome, iliac vein or iliocaval compression syndrome
                                                • Femoral vein = superficial femoral vein
                                              • Definitions

                                                • Venous thromboembolism (VTE)
                                                  • Includes deep vein thrombosis (DVT) & pulmonary embolism (PE)
                                                  • Significant source of morbidity & mortality
                                                  • Occurs in 1:1,000 people yearly
                                                • Catheter-directed thrombolysis (CDT)
                                                  • Delivery of fibrinolytic agent directly into thrombus via intravascular catheter
                                                  • Allows ↑ dose of fibrinolytic into thrombus
                                                  • ↓ fibrinolytic bypassing thrombus via collaterals
                                                  • May ↓ total fibrinolytic dose, treatment/hospitalization time
                                                • Mechanical thrombectomy (MT)
                                                  • Removal of thrombus without lytics; removes risk of lytic-related hemorrhage
                                                  • Often involves aspiration devices
                                                • Pharmacomechanical thrombolysis (PMT)
                                                  • Thrombolytic infusion + mechanical thrombus disruption
                                                  • ↑ contact area between fibrinolytic & thrombus
                                                  • May improve thrombolytic action, further decreasing fibrinolytic dose & treatment/hospitalization time
                                                • Chronic venous insufficiency (CVI)
                                                  • Venous reflux & ambulatory venous hypertension
                                                  • Result of damaged, incompetent valves & venous obstruction
                                                • DVT: Formation of blood clot(s) in deep veins (usually lower extremities), often accompanied by inflammation (thrombophlebitis)
                                                  • Anatomic distribution
                                                    • Iliofemoral DVT: Includes any part of iliac vein &/or common femoral vein (CFV)
                                                      • High incidence of recurrent hospitalizations
                                                      • High incidence of postthrombotic venous ulceration
                                                    • Femoropopliteal DVT: Involvement limited to popliteal, femoral, &/or deep femoral veins
                                                    • Calf DVT: Involves any of paired deep calf veins
                                                      • Peroneal, anterior, &/or posterior tibial veins
                                                      • Calf DVT does not include popliteal vein
                                                  • Duration of positive DVT symptoms/imaging tests
                                                    • Acute DVT: < 14 days duration
                                                    • Subacute DVT: 15-28 days duration
                                                    • Chronic DVT: > 28 days duration
                                                  • DVT involves left leg 3-5x more than right
                                                    • Likely due to May-Thurner anatomy/syndrome
                                                  • More severe initial symptoms with iliofemoral compression/occlusion than with more distal DVT
                                                    • Much greater likelihood of developing postthrombotic syndrome (PTS)
                                                  • Responsible for > 250,000 hospitalizations in USA/year
                                                  • Risk factors: Acute medical illness, antiphospholipid syndrome, active cancer, inherited thrombophilia, later age, long-distance travel, major trauma, obesity, oral contraceptives/hormone replacement therapy, paralytic stroke or immobilization, pregnancy, previous VTE, recent surgery, varicose veins
                                                • Postthrombotic syndrome (PTS): Late DVT sequela
                                                  • 20-40% of 1st-time, acute, iliofemoral DVT develop PTS within 2 years
                                                    • 5-10% develop severe PTS
                                                    • Recurrent ipsilateral DVT associated with 2-6x ↑ risk of PTS
                                                  • Result of chronic venous hypertension
                                                    • Due to valvular reflux & venous obstruction
                                                      • Post-DVT valvular damage leads to reflux
                                                      • Thrombosed veins impair venous return
                                                  • Severity: Villalta scale of PTS
                                                    • Scoring with rating for each sign/symptom of 0 (none), 1 (mild), 2 (moderate), 3 (severe)
                                                      • < 5 = no PTS, 5-14 = mild/moderate PTS, ≥ 15 = severe PTS
                                                    • Patient symptoms
                                                      • Pain (at rest or with ambulation), cramping, heaviness, itching, numbness
                                                    • Clinical signs
                                                      • Redness, hyperpigmentation, skin induration, venous ectasia, pretibial edema
                                                    • Additional signs/symptoms
                                                      • Venous claudication, skin lipodermatosclerosis & ulceration, worsening of symptoms with upright position/activity
                                                • May-Thurner anatomy: Incidental finding; no associated DVT
                                                  • Left iliac vein compressed obliquely & anteriorly by right iliac artery
                                                    • Right iliac artery compresses vein against spine
                                                    • Occurs near iliac venous confluence into inferior vena cava (IVC)
                                                  • Very common finding
                                                    • Incidence: Female (41%) > male (27%)
                                                    • Rarely symptomatic
                                                • May-Thurner syndrome: Symptomatic finding; DVT present
                                                  • Left iliac vein compressed obliquely & anteriorly by right iliac artery
                                                    • Right iliac artery compresses vein against spine
                                                    • Occurs near iliac venous confluence into IVC
                                                    • Produces endoluminal fibrous venous scar
                                                      • Well seen by intravascular US (IVUS)
                                                      • Termed venous "spur" by surgeons & pathologists
                                                • Phlegmasia alba dolens: Massive venous thrombosis-associated lower extremity swelling without cyanosis
                                                • Phlegmasia cerulea dolens: Massive venous thrombosis-associated lower extremity swelling with limb-threatening cyanosis of lower extremity
                                                • Proximal/distal thrombus: Society for Vascular Surgery (SVS) recommends use of precise anatomic terminology (e.g., iliofemoral, femoropopliteal, calf) instead of describing thrombus as proximal/distal
                                                  • Report with/without extension into IVC

                                              PREPROCEDURE

                                              • Indications

                                                • Contraindications

                                                  • Preprocedure Imaging

                                                    • Getting Started

                                                      • Society Guidelines

                                                        PROCEDURE

                                                        • Procedure-Specific Goals

                                                          • Patient Position/Location

                                                            • Procedure Steps

                                                              • Findings and Reporting

                                                                • Alternative Procedures/Therapies

                                                                  POST PROCEDURE

                                                                  • Things to Do

                                                                    OUTCOMES

                                                                    • Problems

                                                                      • Complications

                                                                        • Expected Outcomes

                                                                          Selected References

                                                                          1. Kutsenko O et al: Iliac vein stenosis: is the data strong enough for stenting in the young pelvic venous disorders (PeVD) population? Tech Vasc Interv Radiol. 24(1):100733, 2021
                                                                          2. Robertson B et al: Technical success and short-term results from mechanical thrombectomy for lower extremity iliofemoral deep vein thrombosis using a computer aided mechanical aspiration thrombectomy device. J Vasc Surg Venous Lymphat Disord. ePub, 2021
                                                                          3. Shah NG et al: Management of inferior vena cava thrombosis with the FlowTriever and ClotTriever systems. J Vasc Surg Venous Lymphat Disord. 9(3):615-20, 2021
                                                                          4. Stevens SM et al: Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 160(6):e545-608, 2021
                                                                          5. Vedantham S et al: Clinical outcomes of a pharmacomechanical catheter-directed venous thrombolysis strategy that included rheolytic thrombectomy in a multicenter randomized trial. J Vasc Interv Radiol. 32(9):1296-1309.e7, 2021
                                                                          6. Benarroch-Gampel J et al: Technical success and short-term outcomes after treatment of lower extremity deep vein thrombosis with the ClotTriever system: a preliminary experience. J Vasc Surg Venous Lymphat Disord. 8(2):174-81, 2020
                                                                          7. Kahn SR et al: Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 8(1):8-23.e18, 2020
                                                                          8. Masuda E et al: The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology. J Vasc Surg Venous Lymphat Disord. 8(4):505-525.e4, 2020
                                                                          9. Expert Panel on Interventional Radiology: ACR Appropriateness Criteria® radiologic management of venous thromboembolism-inferior vena cava filters. J Am Coll Radiol. 16(5S):S214-26, 2019
                                                                          10. Magnuson EA et al: Cost-effectiveness of pharmacomechanical catheter-directed thrombolysis versus standard anticoagulation in patients with proximal deep vein thrombosis: results from the ATTRACT trial. Circ Cardiovasc Qual Outcomes. 12(10):e005659, 2019
                                                                          11. Chick JFB et al: Endovascular iliocaval reconstruction for chronic iliocaval thrombosis: the data, where we are, and how it is done. Tech Vasc Interv Radiol. 21(2):92-104, 2018
                                                                          12. Shamimi-Noori SM et al: Venous stents: current status and future directions. Tech Vasc Interv Radiol. 21(2):113-6, 2018
                                                                          13. Tritschler T et al: Venous thromboembolism: advances in diagnosis and treatment. JAMA. 320(15):1583-94, 2018
                                                                          14. Mousa AY et al: Catheter-directed thrombolysis versus full anticoagulation alone in treating proximal iliofemoral deep venous thrombosis. Vascular. 25(1):111-2, 2017
                                                                          15. Kearon C et al: Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 149(2):315-52, 2016
                                                                          16. Birn J et al: May-Thurner syndrome and other obstructive iliac vein lesions: meaning, myth, and mystery. Vasc Med. 20(1):74-83, 2015
                                                                          17. Comerota AJ: Catheter-directed thrombolysis for iliofemoral deep vein thrombosis: helpful or hurtful? Expert Rev Hematol. 8(2):131-3, 2015
                                                                          18. Du GC et al: Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis. Vasa. 44(3):195-202, 2015
                                                                          19. Vedantham S: Interventional therapy for venous thromboembolism. J Thromb Haemost. 13 Suppl 1:S245-51, 2015
                                                                          20. Kahn SR et al: Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet. 383(9920):880-8, 2014
                                                                          21. Enden T et al: Health-related quality of life after catheter-directed thrombolysis for deep vein thrombosis: secondary outcomes of the randomised, non-blinded, parallel-group CaVenT study. BMJ Open. 3(8):e002984, 2013
                                                                          22. Vedantham S et al: Rationale and design of the ATTRACT study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J. 165(4):523-530.e3, 2013
                                                                          23. Enden T et al: Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet. 379(9810):31-8, 2012
                                                                          24. Kearon C et al: Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 141(2 Suppl):e419S-94S, 2012
                                                                          25. Meissner MH et al: Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 55(5):1449-62, 2012
                                                                          26. Broholm R et al: Acute iliofemoral venous thrombosis in patients with atresia of the inferior vena cava can be treated successfully with catheter-directed thrombolysis. J Vasc Interv Radiol. 22(6):801-5, 2011
                                                                          27. Chinsakchai K et al: Trends in management of phlegmasia cerulea dolens. Vasc Endovascular Surg. 45(1):5-14, 2011
                                                                          28. Jaff MR et al: Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 123(16):1788-830, 2011
                                                                          29. Karthikesalingam A et al: A systematic review of percutaneous mechanical thrombectomy in the treatment of deep venous thrombosis. Eur J Vasc Endovasc Surg. 41(4):554-65, 2011
                                                                          30. Khan IR et al: Simultaneous arterial and venous ultrasound-assisted thrombolysis for phlegmasia cerulea dolens. Ann Vasc Surg. 25(5):696, 2011
                                                                          31. Maleti O et al: Reconstructive surgery for deep vein reflux in the lower limbs: techniques, results and indications. Eur J Vasc Endovasc Surg. 41(6):837-48, 2011
                                                                          32. Popuri RK et al: The role of thrombolysis in the clinical management of deep vein thrombosis. Arterioscler Thromb Vasc Biol. 31(3):479-84, 2011
                                                                          33. Sarlon G et al: Congenital anomalies of inferior vena cava in young patients with iliac deep venous thrombosis. Ann Vasc Surg. 25(2):265, 2011
                                                                          34. Donati F et al: An uncommon clinical condition: chronic thrombosis of the inferior vena cava. A case report and review of literature. Monaldi Arch Chest Dis. 74(1):36-9, 2010
                                                                          35. Golarz SR et al: Use of Wall stent to exclude a thrombosed inferior vena cava filter. Ann Vasc Surg. 24(5):690, 2010
                                                                          36. Suwanabol PA et al: Syndromes associated with the deep veins: phlegmasia cerulea dolens, May-Thurner syndrome, and nutcracker syndrome. Perspect Vasc Surg Endovasc Ther. 22(4):223-30, 2010
                                                                          37. Muranishi H et al: Thrombo-occlusion of inferior vena cava filter in a patient with polycythemia vera. J Cardiol. 54(2):307-10, 2009
                                                                          38. Wicky ST: Acute deep vein thrombosis and thrombolysis. Tech Vasc Interv Radiol. 12(2):148-53, 2009
                                                                          39. Protack CD et al: Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement. J Vasc Surg. 45(5):992-7; discussion 997, 2007
                                                                          40. Forauer AR et al: Intravascular ultrasound in the diagnosis and treatment of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 13(5):523-7, 2002