PB0436 - 5 Year Experience From a Single Centre of Interventional Radiology Led Thrombectomy in Extensive Lower Limb Deep Vein Thrombosis (DVT)

Background: Patients with acute iliofemoral deep vein thrombosis (DVT) often experience pulmonary embolism (PE), severe presenting limb symptoms, and poor long-term clinical outcomes. Post-thrombotic syndrome (PTS) can produce varying clinical manifestations, but many patients experience limb pain, heaviness, swelling, and fatigue, with some progressing to develop venous stasis skin changes such as skin ulceration. Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial support these observations.

Aims: Our aim is to review the challenges and outcomes associated with extensive iliofemoral DVT in our patients whom underwent thrombectomy.

Methods: We present data of 4 patients over a 5 year period who underwent catheter directed thrombolysis at our institution.

Results: Three girls and one boy aged 14, 14, 15 and 14 years, respectively presented with extensive iliofemoral DVT. The first patient had risk factors of obesity and recent use of combined oral contraceptive pill. She also had pulmonary emboli. The third patient had congenital IVC atresia. Thrombophilia screen was negative in all patients and patients 2 & 4 had no other risk factors. It was felt that patients 1& 4 may have May-Thurner anamoly. All patients tolerated the mechanical and chemical thrombectomy well without bleeding or other complications. A covered endovascular stent was placed in first 3 patients at the level of obstruction- common iliac vein. No recurrence of DVT observed. All patients have continued long term anti-coagulation. None of the patients have developed features of PTS, although follow-up for two patients is of short duration.

Conclusion(s): Although it is clear that patients with iliofemoral DVT deserve special consideration as a high-risk population, careful individualized consideration of the risk-to-benefit ratio of different treatment strategies continues to be important in selecting an optimal approach for specific patients to prevent post-thrombotic sequelae.