Deep vein thrombosis surgery

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Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] ; Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet

Deep Vein Thrombosis Microchapters


Patient Information





Differentiating Deep vein thrombosis from other Diseases

Epidemiology and Demographics

Risk Factors



Natural History, Complications and Prognosis


Diagnostic Approach

Assessment of Clinical Probability and Risk Scores

Assessment of Probability of Subsequent VTE and Risk Scores

History and Symptoms

Physical Examination

Laboratory Findings





Other Imaging Findings


Treatment Approach

Medical Therapy

IVC Filter

Invasive Therapy



Cost-Effectiveness of Therapy

Future or Investigational Therapies

Special Scenario

Upper extremity DVT




Landmark Trials

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Case #1

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Risk calculators and risk factors for Deep vein thrombosis surgery


Operative venous thrombectomy can be considered for the treatment of iliofemoral deep vein thrombosis (DVT), mainly when catheter directed thrombolysis (CDT) and pharmacomechanical catheter directed thrombolysis (PCDT) can not be performed.[1]


A single small randomized controlled trial showed that operative venous thrombectomy and anticoagulation therapy may lead to better iliac vein patency and less post-thrombotic syndrome as compared to anticoagulation therapy alone.[2] Operative venous thrombectomy is invasive and requires general anesthesia. It also carries a small risk of pulmonary embolism. Operative venous thrombectomy should be considered only if all of the following criteria are met:[1]

  • Iliofemoral DVT
  • Symptoms < 7 days
  • Good functional status
  • Life expectancy ≥1 year

2012 American College of Chest Physicians Evidence-Based Clinical Practice Guidelines on Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis (DO NOT EDIT)[1]

Treatment of Acute DVT

Class II
"1. In patients with acute proximal DVT of the leg, we suggest anticoagulant therapy alone over operative venous thrombectomy (Level of Evidence: C)."

2011 AHA Scientific Statement-Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension (DO NOT EDIT)[3]

Recommendations for Endovascular Thrombolysis and Surgical Venous Thrombectomy (DO NOT EDIT)[3]

Class IIb
"1. Surgical venous thrombectomy by experienced surgeons may be considered in patients with IFDVT (Level of Evidence: B)."


  1. 1.0 1.1 1.2 Kearon C, Akl EA, Comerota AJ; et al. (2012). "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. doi:10.1378/chest.11-2301. PMID 22315268. Unknown parameter |month= ignored (help)
  2. Plate G, Eklöf B, Norgren L, Ohlin P, Dahlström JA (1997). "Venous thrombectomy for iliofemoral vein thrombosis--10-year results of a prospective randomised study". Eur J Vasc Endovasc Surg. 14 (5): 367–74. PMID 9413377.
  3. 3.0 3.1 Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ; et al. (2011). "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. doi:10.1161/CIR.0b013e318214914f. PMID 21422387.

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