The long-term clinical impact of iliofemoral deep vein thrombosis

Objective: Current literature shows a general lack of specificity and uniformity when objectively evaluating the long-term effects of iliofemoral deep vein thrombosis (IFDVT). The main purpose of our study was to follow the natural history of an IFDVT, treated with anticoagulation alone, in patients with a minimum of 5-year follow-up. Methods: This study included patients with a minimum of 5-year follow-up treated with anticoagulation alone. Patients who underwent additional interventional treatments, those with previous episode of deep vein thrombosis (DVT), immobility, severe comorbidities, systemic organ failures, chronic venous disease, and lymphedema were excluded. Bilateral lower limb ultrasound study was performed, and the limbs without DVT were used as a control group to compare outcomes. Every patient had clinical examination and a detailed duplex ultrasound guidance to evaluate reflux, obstruction, and recanalization at follow-up. Results: A total of 34 patients (68 limbs) were included in the study. Of these, 38 limbs had IFDVT and comprised the study group. Patients had a mean age of 49 ± 11 years. Of the limbs studied, 84.2% exhibited edema, 26% had skin damage, and three limbs presented with venous ulcers during follow-up. Venous claudication was observed in 18.4% of limbs, exclusively associated with multisegmented DVT. Ultrasound findings revealed 34.2% of the limbs had persistent obstruction. Reflux and obstruction were present in 57.9% of limbs with IFDVT. Limbs with both reflux and obstructions were significantly more likely to present with symptoms compared to limbs with either reflux or obstruction alone. The affected limbs were significantly more likely to have signs of post-thrombotic syndrome when compared with the contralateral unaffected limbs. Conclusions: Our study highlights the unfavorable long-term outcomes in patients with IFDVT who are managed with standard anticoagulation alone. Therefore, consideration of additional strategies may be beneficial to reduce the incidence of post-thrombotic syndrome, and the long-term follow-up is essential to monitor symptom progression.