Comparative Study Between Medical Treatment and Intervention in Acute Iliofemoral DVT

Abstract

Abstract Background The cornerstone of current management of deep vein thrombosis (DVT) are the routine use of anticoagulant therapy, graduated elastic compression stockings (ECS), and early ambulation. Thrombolytic therapy was previously reserved only for patients with life-, limb-, or organ-threatening complications. However, the Post-Thrombotic Syndrome (PTS) has been increasingly recognized as a frequent and serious long-term complication of DVT. In this study I will use systematic review techniques to compare between the medical and intervention management outcome and possible complications and I will try to find out if although of high expenses of the new techniques especially catheter directed thrombolysis CDT it worth it as regarding the post-operative care and complications. Objective To review the literature comparing between medical treatment of acute iliofemoral DVT and intervention in the form of endovenous or surgical management of acute iliofemoral DVT as regards short and long term benefits. Methodology A systematic Review of published English literature from their date of inception till 2018. Only published English literature will be included in the study. All studies from their inception date till 2018 will be included. Results The literature search from the specified electronic databases identified 179 articles. After application of the inclusion and exclusion criteria, 7 comparative studies were finally included in this systematic review. There were 5 randomized trials and 2 observational studies. 1 prospective and 1 was retrospective. Various other approaches were used in combination with conservative/pharmacological thrombolysis according to the underlying pathology A total of 631 patients underwent CDT compared to 675 patients who underwent conservative strategy for management of acute iliofemoral DVT Conclusion Pharmacological and pharmacomechanical thrombolysis offers significant benefits to proximal dvt patients in the long term period. However, it does not show an advantage over conservative management in short -term outcome. Furthermore, CDT carries more risk of bleeding and recurrent VTE in the shortterm. More randomized control studies focused on quality of life after conservative and endovasculat intervention in proximal dvt patients as well as on studies on newer generation devices is needed to provide more information for clinical decisions.