Indications for surgical treatment of iliofemoral vein thrombosis

Iliofemoral vein thrombosis (IFVT) implies a high risk for future post-thrombotic syndrome (PTS), and rapid removal of the acute IFVT is mandatory to prevent PTS. Current management of acute IFVT is primary catheter-directed intrathrombus thrombolysis (CDITT) with or without adjunct procedures such as angioplasty and stenting. When there are contraindications or failure of the CDITT, surgical treatment comprised of thrombectomy with a temporary arteriovenous fistula is a valid alternative. Both interventions should be followed by anticoagulation. These comparable aggressive procedures are not justified in chronically ill, bedridden, high-risk, or aged patients or in patients with limited life expectancy.