72 year old male patient with 3 left lower extremity DVT's. Patient was developing severe post thrombotic syndrome (PTS). The patient was positive for Lupus anticoagulant was being treated with oral anticoagulation. Apart from a lower extremity venous ultrasound no investigation of the pelvic venous system was done. Imaging of the venous outflow in the abdomen and pelvis showed severe compression of the left external iliac vein. Intravascular ultrasound confirmed the compression and treatment with stenting and venoplasty was performed. The patients symptoms of PTS improved. Had the patient been treated earlier, they would have a better long term outcome. Patients with recurrent DVT or with unprovoked DVT should be evaluated for iliac vein compression.
Endovascular repair of an anastomic stenosis of a aortobifemoral bypass graft using JetStream atherectomy
Percutaneous bypass graft for severe critical limb ischemia
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.