Iliofemoral Venous Thrombosis Research Articles

The role and principles of stenting in acute iliofemoral venous thrombosis

The role and principles of stenting in acute iliofemoral venous thrombosis

Prevention and treatment of venous thromboembolic complications in orthopedic patients

To analyze the comprehensive program for prevention of thromboembolic complications in orthopedic patients. We have analyzed thromboembolic complications in orthopedic patients after surgeries on large joints over the past 5 years (2018-2022). A comprehensive approach to prevention and treatment of thromboembolic complications including ultrasound, early surgical prevention of pulmonary embolism can significantly improve postoperative outcomes after joint replacement surgery. Vacuum aspiration retrograde thrombectomy is effective, feasible and safe for acute ilio-femoral venous thrombosis reducing hospital-stay (p=0.0124) and restoring vein patency. Widespread thromboembolic complications, especially for pulmonary embolism in 2022, are likely due to a new coronavirus infection and require careful screening of patients with risk factors with appropriate preventive antithrombotic therapy.

Delphi Consensus on Reporting Standards in Clinical Studies for Endovascular Treatment of Acute Iliofemoral Venous Thrombosis and Chronic Iliofemoral Venous Obstruction.

Acute iliofemoral deep vein thrombosis and chronic iliofemoral venous obstruction cause substantial patient harm and are increasingly managed with endovascular venous interventions, including percutaneous mechanical thrombectomy and stent placement. However, studies of these treatment elements have not been designed and reported with sufficient rigor to support confident conclusions about their clinical utility. In this project, the Trustworthy consensus-based statement approach was utilized to develop, via a structured process, consensus-based statements to guide future investigators of venous interventions. Thirty statements were drafted to encompass major topics relevant to venous study description and design, safety outcome assessment, efficacy outcome assessment, and topics specific to evaluating percutaneous venous thrombectomy and stent placement. Using modified Delphi techniques for consensus achievement, a panel of physician experts in vascular disease voted on the statements and succeeded in reaching the predefined threshold of >80% consensus (agreement or strong agreement) on all 30 statements. It is hoped that the guidance from these statements will improve standardization, objectivity, and patient-centered relevance in the reporting of clinical outcomes of endovascular interventions for acute iliofemoral deep venous thrombosis and chronic iliofemoral venous obstruction in clinical studies and thereby enhance venous patient care.

Venous Thromboembolism in a Patient with Interrupted Inferior Vena Cava and Compressed Azygos Continuation: A Case Report and Review of Literature.

We report an unusual case of a 40-year-old male patient who experienced painful swelling of the left lower limb that persisted for 1week. Imaging modalities not only confirmed the diagnosis of acute iliofemoral venous thrombosis and pulmonary embolism (PE), but also an incidental finding of interrupted inferior vena cava (IVC). This congenital anomaly is uncommon but rarely associated with venous thromboembolism (VTE). The azygos continuation was compressed by the descending aorta against the 11th thoracic vertebrae, which was identified as the cause of VTE. He was treated successfully with anticoagulation and compression therapy. The patient was discharged with lifelong oral Rivaroxaban and remained asymptomatic. In the literature, only 9 cases of interrupted IVC-associated PE were identified but none was due to significant venous compression.

Multi-factor analysis of failure for modified single-session Angiojet rheolytic thrombectomy in treatment of acute iliofemoral venous thrombosis from iliac vein compression syndrome.

To explore the risk factors of failure for modified single-session Angiojet rheolytic thrombectomy combined with directed iliac vein stenting, directed filter retrieval in the treatment of iliac vein compression with iliofemoral vein thrombosis. During September 2017 to September 2021, 278 patients with DVT were retrospectively analyzed and 203 were eligible for inclusion. All patients were tried to take modified single-session Angiojet rheolytic thrombectomy combined with directed iliac vein stenting, directed filter retrieval treatment. The perioperative factors were analyzed between groups: group 1-modified single-session therapy succeed, and group 2-modified single-session therapy failed. The high risk factors of failure group were evaluated by logistic regression analysis. 48 patients failed in modified single-session therapy, up to 23.64%. Single factor analysis indicated that there were five independent risk factors related with the failure (p < 0.05), including course of disease longer than 7days, lumbar degeneration-related iliac vein compression syndrome (dIVCS), antegrade vein access, balloon-assisted cracking thrombus, and suction time. Logistic regression analysis indicated that course of disease longer than 7days (OR = 19.642.95%CI:6.776∼56.933), dIVCS (OR = 11.586.95%CI:4.016∼33.427) were high risk factors for modified single-session therapy failed, antegrade vein access (OR = 0.171.95%CI:0.047∼0.614) and balloon-assisted cracking thrombus (OR = 0.157.95%CI:0.045∼0.542) were protective factors for therapy failure (p < 0.05). Long course of disease and dIVCS are the high risk factors for failure of modified single-session Angiojet rheolytic thrombectomy combined with directed iliac vein stenting, directed filter retrieval in the treatment of iliac vein compression syndrome (IVCS). But, antegrade vein access and balloon-assisted cracking thrombus intraoperatively may improve the success rate of modified single-session treatment.

Clinical and radiological outcomes of adjuvant catheter-directed thrombolysis of acute iliofemoral venous thrombosis compared to standard anticoagulant therapy: a randomized controlled study

Clinical and radiological outcomes of adjuvant catheter-directed thrombolysis of acute iliofemoral venous thrombosis compared to standard anticoagulant therapy: a randomized controlled study

Endovascular Thrombus Removal for Treating Post-Partum Iliofemoral Deep Vein Thrombosis: A Single-Centre Retrospective Cohort Study.

To evaluate the safety and efficacy of percutaneous thrombectomy for treating postpartum iliofemoral vein thrombosis. A retrospective analysis was performed on patients with continuous postpartum acute symptomatic iliofemoral deep vein thrombosis who were treated in our center, including all patients who underwent pharmacomechanical thrombolysis (PMT) or only catheter-directed thrombolysis (CDT) (study group), and patients that received simple anticoagulation treatment (control group). We evaluated the incidence of lower extremity postthrombotic syndrome, recanalization rate of lower extremity veins, and complications in the study and control groups. Overall, 72 postpartum women were included in this study, including the PMT combined with CDT group (14 cases, 15 limbs), CDT alone group (26 cases, 27 limbs), and anticoagulant therapy alone group (32 cases, 34 limbs). The thrombectomy group completed the treatment with a technical success rate of 100%, and no serious bleeding complications occurred. The patency rate of lower limb veins in the thrombectomy group was 85.09 ± 16.51% after treatment and 82.60 ± 21.45% after 1 year. At the 1-year follow-up, the Villalta score in the study group was lower (1.90 ± 2.45 vs 8.50 ± 5.33, P < .001), and the incidence of postthrombotic syndrome was significantly different between the groups (17.50% in the study group vs 68.75% in the anticoagulant group, P < .001). Lower extremity venous thrombectomy is a safe and effective treatment for postpartum iliofemoral venous thrombosis. It can improve the patency rate of lower extremity veins and reduce the incidence of postthrombotic syndrome compared with anticoagulation alone.

Improvement following restoration of inline flow argues against comprehensive thrombus removal strategies and for selective stenting in acute symptomatic iliofemoral venous thrombosis

ObjectiveRandomized trials have demonstrated the benefit of thrombus removal strategies in iliofemoral deep venous thrombosis (IFDVT) in providing early symptom relief and decreasing the incidence of post-thrombotic syndrome (PTS), especially severe PTS. However, the impact of quantum of residual thrombus burden (RTB) on PTS as determined by intravascular ultrasound examination and the role of venous stenting in the acute setting have not been evaluated and represent the focus of this study. MethodsSixty-nine limbs (65 patients) undergoing thrombus removal for acute symptomatic IFDVT between 2015 and 2021 formed the study cohort. The Venous Clinical Severity Score (VCSS) (range, 0-27) grade of swelling (GOS) (range, 0-4), and visual analog scale (VAS) pain scores (range, 0-10) were evaluated initially and at 6, 12, and 24 months after thrombus removal. Quality of life was appraised using the CIVIQ-20 instrument. The extent of initial and RTB after the intervention was estimated using intravascular ultrasound examination. Grading was done as less than 50% (1), 50% to 99% (2), or 100% (3) of luminal thrombus fill within each segment (common femoral vein, external iliac vein, and common iliac vein) by a blinded rater and then combined to generate a total score. The use of stenting, both concurrent (severe residual stenosis/persistent occlusion) and delayed (quality of life impairing residual or recurrent symptoms), was evaluated. ResultsOf the 69 limbs, 53 underwent pharmacomechanical/mechanical thrombectomy (PMT), whereas 16 patients underwent PMT and catheter-directed thrombolysis with restoration of inline flow in all limbs. Post-intervention VCSS improved from 6 to 2 at 24 months (P < .0001). GOS improved from 4 to 0 at 24 months (P < .0001). The VAS pain score went from 5 to 0 at 6 months (P < .0001) and remained at 0 at 12 months (P < .0001), but increased to 3 at 24 months (P = .02). The CIVIQ-20 score improved from 38 to 22 (P = .001) over a median follow-up of 19 months. The median RTB total score improved from 9 to 4 (P < .0001). There was no impact of RTB total score (<3 vs >3) on VCSS (P = NS), GOS (P = NS), VAS pain score (P = NS) or CIVIQ-20 score (P = NS) at the various time points. Concurrent stenting was used in 23 limbs (33%) and delayed stenting was carried out in 10 limbs (14%). The median time to delayed stenting was 4 months after the initial thrombus removal intervention. ConclusionsIn patients undergoing PMT or PMT with catheter-directed thrombolysis for acute symptomatic IFDVT, the restoration of inline flow seems to be adequate to provide symptom relief and decrease the incidence of PTS. The extent of RTB does not seem to impact the VCSS, GOS, VAS pain score, or quality of life after such restoration. Stenting can be pursued selectively in the acute setting to help restore inline flow.

Ilio-femoral venous thrombosis in a young patient? Think of May-Thurner Syndrome!

Ilio-femoral venous thrombosis in a young patient? Think of May-Thurner Syndrome!

Up-and-over access is not an optimal pathway for percutaneous catheter-directed thrombolysis in acute iliofemoral popliteal venous thrombosis.

To analyze the feasibility and results of up-and-over access (UOA) for catheter-directed thrombolysis (CDT) in acute iliofemoral popliteal venous thrombosis (IFPVT). From June 2020 to June 2021, a total of 26 patients (26 lower limbs) undergoing CDT for IFPVT were included. According to the vascular access, the patients were divided into UOA group (n = 11, 10 left limbs and 1 right limb) and ipsilateral popliteal vein (ILPV) (n = 15, 15 left limbs) access group. The differences in preoperative characteristics and technical details between the two groups were compared. Patients in UOA group were older than those in ILPV access group (67.64 ± 4.11years VS. 52.73 ± 15.63years, p = .003). The BMI of UOA group was significantly higher than that of ILPV access group (26.03 ± 1.62kg/m2 VS 24.71 ± 1.46kg/m2, p = .039). There were significantly more patients with simultaneous three comorbidities in UOA group than in ILPV access group (45.5% vs. 0, p = .043). Compared with ILPV access group, the duration of operation and fluoroscopy of UOA group were significantly longer (20.64 ± 3.41min vs. 10.20 ± 1.42min, p < .001; 18.18 ± 2.99min vs. 6.13 ± 0.92min, p < .001), but the technical success rate was significantly lower (54.5% vs. 100%, p = .007). In UOA group, the operation-related complications occurred, including catheter straying into lateral sacral vein (9.1%), retroperitoneal hematoma (9.1%), and thrombus shedding into filter (9.1%). The UOA may be attempted in patients who are unable to be prone, but this access is not an optimal pathway for CDT.

Improvement following Restoration of Inline Flow Argues against Comprehensive Thrombus Removal Strategies and for Selective Stenting in Acute Symptomatic Iliofemoral Venous Thrombosis

Randomized trials have demonstrated the benefit of thrombus removal strategies in iliofemoral deep venous thrombosis in providing early symptom relief and reduction of incidence of post-thrombotic syndrome (PT)S, especially severe PTS. However, the impact of intravascular ultrasound (IVUS) determined quantum of residual thrombus burden on PTS and the role of venous stenting in the acute setting have not been evaluated and represent the focus of this study.

Thrombectomy in a severe case of iliofemoral venous thrombosis involving the deep femoral vein via a single percutaneous access from the jugular vein: case report and description of the technique.

Iliac vein thrombectomy is usually performed via access through veins located in the lower limbs, which makes it impossible to treat the deep femoral vein, which in turn is an important inflow route to the iliac vein stent. We describe a clinical case and the previously unpublished technique of percutaneous thrombectomy, angioplasty, and stent implantation performed in a single session and with a single access, obtained via the internal jugular vein.

Elastic compression stockings to prevent post-thrombotic syndrome in proximal deep venous thrombosis patients without thrombus removal

ObjectiveTo evaluate the effectiveness of elastic compression stockings (ECS) in prevention of post-thrombotic syndrome (PTS) in patients suffering from proximal deep venous thrombosis (DVT) who did not undergo thrombus removal procedures. MethodsIn this randomized trial, patients with Iliofemoral venous thrombosis (IFDVT) and femoral-popliteal venous thrombosis who had not undergone thrombus removal procedures were screened at a single medical institution between December 2016 and June 2018. These patients were randomly assigned as an ECS group (wear ECS) and control group (not wear ECS). The primary end point was the incidence of PTS based on the Villalta scale at 24 months. The secondary end points included patient quality of life and symptom severity based on the VEINES-QoL/Sym questionnaire. Recurrent DVT in the same limb, compliance with ECS use, and other adverse events were also recorded. A logistic regression analysis was also performed to determine risk factors of PTS. ResultsTwo hundred thirty-two patients were included in this study. One hundred thirteen patients were in the ECS group and 119 in the control group. The incidence of PTS was 42.0% in the ECS group and 57.8% in the control group at 24 months (risk ratio [RR], 0.726; 95% confidence interval [CI] 0.547-0.964; P = .024). The VEINES-QoL score was 63.7 ± 4.6 in the ECS group, which was higher than in the control group (60.6 ± 6.9; P < .001). Moreover, the VEINES-Sym scores revealed that patients in the ECS group reported better symptom relief than those in the control group (45.8 ± 5.1 vs 43.8 ± 6.1; P = .014). According to Logistic regression analysis of the entire cohort, IFDVT was a risk factor for PTS (RR, 2.253; 95% CI, 1.136-4.468) and high compliance with the use of ECS was protect factor (RR, 0.516; 95% CI, 0.277-0.961). ConclusionsThese results suggest that ECS can prevent PTS in patients with IFDVT and femoral popliteal venous thrombosis who do not undergo thrombus removal procedures.

Multidisciplinary staged management of iliofemoral venous thrombosis caused by huge uterine fibroid: a case report

Multidisciplinary staged management of iliofemoral venous thrombosis caused by huge uterine fibroid: a case report

Catheter-directed thrombolysis in iliofemoral thrombosis and aplasia of the inferior vena cava

Demonstrated in the article are the results of catheter-directed thrombolysis in a male patient presenting with bilateral acute iliofemoral venous thrombosis on the background of aplasia of the inferior vena cava. The incidence rate of this pathology is specified, with an emphasis on no recommendations on choosing optimal therapeutic strategy in this cohort of patients. The main causes and complications of the disease are described. The realized policy of revascularization demonstrated its safety and efficacy. The chosen method of correction resulted in a successful outcome of treatment, preventing phlegmasia cerulea dolens. This policy can be recommended as most preferred for patients with acute iliofemoral venous thrombosis on the background of aplasia of the inferior venal cava.

Ilio-femoral venous thrombosis with hereditary antithrombin deficiency: a case report of rare thrombotic disease and successful treatment with catheter directed thrombolysis

BackgroundHereditary antithrombin (AT) deficiency is an uncommon autosomal dominant thrombogenic disorder, which can cause venous thromboembolism (VTE). Although conservative treatment options for hereditary AT deficiency-associated VTE such as anticoagulation (warfarin, direct oral anticoagulant, or heparin), intravenous thrombolysis, and recombinant AT are well known, interventional treatment options have not been reported so far.Case summaryA 19-year-old man with a family history of thrombogenic diseases, referred to our hospital with left leg pain, was diagnosed with AT deficiency-associated VTE. In the absence of symptomatic relief with intravenous thrombolysis and anticoagulation, he received venous intervention and catheter directed thrombolysis (CDT) for 4 days for left iliac venous thrombosis. Following a second venous intervention, venous thrombus disappeared almost entirely on cross-sectional imaging, and his symptoms improved. He was discharged on apixaban and has been recurrence-free for one and a half years.DiscussionThis case presents CDT and maintenance therapy with apixaban as possible treatment options for VTE in patients with hereditary AT deficiency, especially following failure of conservative therapy. Individual risks and benefits should be considered when CDT is performed for acute VTE in patients with AT deficiency.

Suprarenal Inferior Vena Cava Filter Placement and Retrieval: Safety Analysis.

To evaluate safety and retrieval success of retrievable suprarenal inferior vena cava (IVC) filters. A retrospective chart review of patients who received a retrievable suprarenal IVC filter between January 2008 and December 2017 was conducted. Suprarenal IVC filters were placed in 24 female and 27 male patients. The most common indications for filter placement were IVC thrombus (n= 20; 39.2%) and iliofemoral venous thrombosis with contraindication to anticoagulation (n= 16; 31.3%). The most common indications for suprarenal placement were IVC thrombus (n= 20; 39.2%), anatomic variants (n= 17; 33.3%), and external IVC compression (n= 8; 15.8%). Duplicated IVC was the most common anatomic variant requiring suprarenal placement (n= 7; 13.7%). Günther Tulip (n= 40; 78.4%), Denali (n= 10; 19.6%), and Celect (n= 1; 2.0%) filters were used. Retrieval was attempted in 27 of the 51 filters placed (52.9%). Of the 27 attempted retrievals, the technical success rate was 100% (27/27). The median dwell time was 87.0 days (95% confidence interval, 28-137 d). One complication involving fractured struts during filter retrieval occurred. No significant change in craniocaudal filter position, lateral filter tilt, or renal function between placement and retrieval was observed (P < .05). There were no instances of indwelling filter fracture. Suprarenal IVC filters, when indicated, can be placed and retrieved with a low complication rate.

Midterm Results of DVT Treatment: Comparison of Medical and Interventional Modalities

Introduction: The interventional and medical treatment modalities used in the treatment of iliofemoral venous thrombosis were analyzed in terms of outcome, efficiency and the risk of postthrombotic syndrome were analyzed. Methods: Patients who were treated for iliofemoral deep venous thrombosis (DVT) by means of medial and interventional methods were retrospectively analyzed from hospital records and phone interviews. The interventional group (Group I) consisted of 35 patients and the medically treated group (Group M) consisted of 182 patients. The average age of the patients in Group I and Group M were 49.8±16.7 (20-89) and 51.4±18.4 (15-96), respectively (p=0.628). Patients having DVT as provoked/unprovoked, Lower Extremity Thrombosis (LET) scale, final Venous Clinical Severity Scores (VCSS) and Villalta scores in the final interviews were recorded. The LET classification was made based on the initial Doppler USG results. Results: No patients had any mortality in the acute period. Follow-up was complete in 107 patients. The average duration of follow-up was 2.6±2.5 years (1 month-19.7 years), adding up to a total of 278.5 patient/years. The follow-up duration was Group I had more number of proximal involvement according to LET classification (p=0.0001). The rate of recurrent DVT was 22.9% (8 cases) and 13.9% (23 cases) in Group I and Group M, respectively (p=0.198). The average recurrence-free survival durations in Group I and Group M were 1.6±1.8 and 2.2±3.3 years, respectively (p=0.130). The 1- and 2-years recurrence-free survival rates in Group I and Group M were 80.0%±8.1%, 73.3%±9.8% and 92.9%±2.2%,%85.9%±3.7%; respectively (p=0.479) (Graph-1). None of the Group I patients had pulmonary emboli (PE) during follow-up. In Group M, 5 patients had PE during follow-up (p=0.614). The 1, 2 years PE-free survival rate in Group M was 97.1%±2.0% and at 5 years 87.9%±6.6%. The difference between groups were nonsignificant (p=0.312). In the final controls, average Villalta scores in Group I and Group M were 3.0±2.6 (0-11) and 3.0±2.6 (0-11), respectively (p=0.013). The number of patients with Villalta scores >5 were 1 in Group I (3.4%) and 32 in Group M (41.0%) (p=0.0001). The average VCSS were statistically different in Group I and Group M (2.6±3.5 (0-16) and 4.4±3.6 (0-18), respectively) (p=0.027). Anticoagulant related bleeding complications occurred in 8 patients in Group I (27.6%) and in 32 patients in Group M (41.0%) (p=0.195). Conclusion: Although the results of ATTRACT Trial caused a significant debate, interventional treatment after DVT results in lower VCSS and Villalta scores at 2 years. The rate of posthrombotic syndrome is significantly low in patients who received interventional treatment. Interventional therapy options in iliofemoral DVT offers persistent advantage in mid-term follow-up. Disclosure: Nothing to disclose

Prevention of Recurrence After Thrombolysis in Acute Iliofemoral Venous Thrombosis with Rivaroxaban (Prais Study): A Prospective, Randomized, Open Label, Multicenter Trial

Introduction: Recently new oral anticoagulants (NOAC) has replaced vitamin K antagonist (VKA) for the treatment of deep vein thrombosis (DVT). But the role of NOAC after thrombolysis of acute iliofemoral DVT is not yet defined. The aim of this randomized clinical trial is to compare the safety and efficacy of rivaroxaban versus VKA after thrombolysis of acute iliofemoral DVT. Methods: Patients were recruited from 7 hospitals in Korea. After successful thrombolysis or mechanical thrombectomy of acute iliofemoral DVT, 72 patients were randomized to standard anticoagulation (enoxaparin and warfarin) or rivaroxaban. Primary efficacy outcome was recurrence of any venous thromboembolism within 6 months. Secondary safety outcome were major bleeding and clinically relevant non-major bleeding (CRNMB). Other safety variables including any adverse events, vascular events, and all-cause mortality were also analyzed. Results: Intention-to-treat analysis was done for 67 patients (35 in rivaroxaban group, and 32 in VKA group). The primary outcome of recurrent VTE occurred in 4 patients in each group (11.4% vs 12.5%; hazard ratio[HR], 0.90; 95% confidence interval [CI], 0.21 to 3.96; P=1). Major bleeding or CRNMB developed in 1 patient in the rivaroxaban group and 3 patients in the VKA group (2.9% vs 9.4%, HR, 0.28; 95% CI, 0.03 to 2.88; P=0.34). Recurrence-free survival and significant bleeding-free survival at 6 month were not different in both groups. (P=0.28 and P=0.98, respectively) Conclusion: After thrombolysis of acute iliofemoral DVT, rivaroxaban was as effective as warfarin for the prevention of DVT recurrence. Rivaroxaban group showed a tendency of lower incidence of major bleeding/CRNMB. Rivaroxaban can safely replace warfarin in patients after successful thrombolysis for acute iliofemoral DVT. (Funded by Bayer Schering Pharma; ClinicalTrials.gov number, NCT01986192.)

PO 18124 - Large orthopedic surgery and its correlation with Cockett syndrome

Introduction: Cockett syndrome (CS) is characterized by compression of the left common iliac vein by the right common iliac artery against the spinal wall, causing obstruction of left lower limb (LLL) blood flow. The clinical condition is mainly manifested by pain and edema of the LLL and, in more severe cases, even by left iliofemoral venous thrombosis. It is already well established in the literature that in cases such as Cockett syndrome, orthopedic surgeries also corroborate the occurrence of deep vein thrombosis (DVT), mainly by the positioning and manipulation of the limb during the intervention; by the continuous reaction secondary to the use of cement; by significant blood loss; by postoperative (PO) edema; and by the mobility limitations PO. Case report: A 42-year-old patient complained of left foot pain and repetitive sprains for 2 years. After a complete physical examination indicating a cavovarus foot and a pointed hindfoot, an AP and profile radiograph of the limb was requested, which revealed data compatible with a foot cavity. The nuclear magnetic resonance demonstrated the necessity for cavo foot correction surgery and reconstruction of the structure of the ankle. The patient was classified as ASA 1 and had no indication for prophylaxis for DVT according to the Hospital Protocol. The surgical procedure occurred without intercurrences, and the patient was discharged in good general condition in the 2nd PO with guidelines and prescriptions. The patient returned to the foot clinic on the 7th PO complaining of abrupt pain in the LLL, accompanied by edema, hyperemia and cyanosis of the limb. A Doppler ultrasonography was performed, which detected extensive thrombosis of the iliac vein and compression of the same by the contralateral iliac artery, raising the hypothesis of CS. In the present paper, the exam images, surgery, PO and evolution for the DVT will be presented and discussed, as well as the resolution of this condition through endovascular surgery with angioplasty and stent implantation. Conclusion: CS and orthopedic surgeries are, in isolation, important risk factors for the development of DVT and, above all, when overlapped, they increase this risk exponentially. Endovascular surgery with angioplasty and stent implantation is the main form of treatment, presenting excellent clinical results.