Retrievable Inferior Vena Cava Filters Research Articles

Making Invaluable Changes: Assessing Appropriateness for IVC Filter Insertion and Reasons for Non-Retrieval

Background:Inferior vena cava (IVC) filters are commonly placed in patients with contraindications to anticoagulation including bleeding concurrent with venous thromboembolism (VTE). Retrievable IVC filters have been preferred over permanent filters for their flexibility to be removed once anticoagulation can be resumed. Published reports show that the retrieval rate of the filters is around 34%. Non-retrieved filters can result in significant complications such as filter migration, embolization, filter fracture, vena cava thrombosis, and IVC perforation.Objective:The primary objective of this study is to assess IVC filter insertion indications, retrieval rate and factors prohibiting timely retrieval.Methods:A retrospective chart review was conducted on patients with a history of IVC filter placement and/or removal between January 2012 and January 2017. Data collected included demographics, indications for filter placement, referring and placement services and the reasons for non-retrieval.Results:A total of 573 patients were identified of which 343 patients had IVC filters inserted without retrieval, 200 patients had placement followed by retrieval and 30 patients who had retrieval alone. Reasons for placement included VTE with active bleed in 29.48%, trauma, surgery, or immobilization in 22.01%, VTE with planned surgery in 19.22%, history of VTE with planned surgery in 11.94%, and extensive clot burden in 9.33%, VTE with elevated bleeding risk in 3.92%, PE with thrombolysis therapy in 0.19%, and other in 3.92% of patients. Internal medicine had ordered IVC filters in 44.44% of patients compared to 27.16% in surgical services with (p-value of 0.0028). This indicates that a significantly greater proportion of IVC filters were placed due to VTE with active bleeding in internal medicine as opposed to all other departments. In addition, Internal medicine ordered IVC filters for immobilization from trauma in 4.23% of patients compared to 24.73% by other departments (p-value <0.0001), indicating that other departments order IVC filters for immobilization or bleeding from trauma at a significantly higher rate than does internal medicine.For those 343 patients who had IVC filters placed but not retrieved, reasons for non retrieval by Interventional radiology(IR) included lost to follow up in 39.80% compared to 58.97% in vascular surgery, decided to use as permanent IVC filter in 20.72% in IR compared to 12.82% in vascular surgery, ongoing thrombosis in 4.93% in IR compared to 7.69% in vascular surgery, trapped clots in 1.32% in IR compared to 0% in vascular surgery, died within 3 months in 31.58% in IR compared to 15.38% in vascular surgery, filter removed locally in 0.99% in IR compared to 5.13% in vascular surgery, and scheduled to be removed in 0.66% in IR compared to 0% vascular surgery.To further investigate the rates of patients that were “lost to follow up” we dichotomized the reasons into “lost to follow up” in comparison to all other reasons. This showed that the reason for non-retrieval was lost to follow up in 39.80% compared to 58.97% of patients in vascular surgery (p-value 0.0224). This indicates that the proportion of patients that were “lost to follow up” in vascular surgery is significantly higher than in interventional radiology.Conclusion:Only one-third of IVC filters were ordered in compliance to current evidence based guidelines. There was also a significantly greater proportion of “lost to follow up” patients in vascular surgery compared to interventional radiology, indicating room for improvement regarding patient follow up. To improve the appropriateness of IVC filter insertion and overall retrieval rate, we plan to implement best practice alerts and institutional guidelines along with hematology referral upon patient discharge to aid in timely retrieval. We plan to reevaluate our practice in 6 months following the implementation of these guidelines. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Antenatal venous thromboembolism

Key content Venous thromboembolism (VTE) remains one of the leading causes of maternal mortality and morbidity in the developed world. Clinical diagnosis of antenatal VTE is difficult and scoring systems have historically been of limited benefit in the pregnant population. However, evidence is emerging to suggest that pregnant women can be risk stratified for pulmonary embolism without the need for imaging in all cases. Optimal treatment is with weight adjusted therapeutic dose low‐molecular‐weight heparin (LMWH) subcutaneously. In rare cases, there may be a role for retrievable inferior vena cava (IVC) filters. The obstetrician has a key role in the multidisciplinary team discussion with the aim of minimising maternal risk of haemorrhage or thrombosis. Learning Objectives To understand the optimal approach to diagnosing VTE in pregnancy and the antenatal management of acute VTE. To understand the rare indications, risks and benefits of IVC filters in pregnancy. To understand the complexity of decision making around the time of delivery to minimise the risk of bleeding and recurrent thrombosis.

Retroperitoneal Laparoscopic-Assisted Retrieval of Wall-Penetrating Inferior Vena Cava Filter After Endovascular Techniques Failed: An Initial Clinical Outcome.

Inferior vena cava (IVC) filters are commonly used in China to prevent pulmonary embolisms in patients with deep vein thrombosis. However, IVC filter removal is complicated when the filter has penetrated the IVC wall and endovascular techniques usually fail. The purpose of this study was to evaluate the effectiveness and safety of retroperitoneal laparoscopic-assisted retrieval of wall-penetrating IVC filters after endovascular techniques have failed. We retrospectively evaluated a series of 8 patients who underwent retroperitoneal laparoscopic-assisted retrieval of a wall-penetrating IVC filter between December 2017 and November 2019. All patients had experienced at least 1 failure with endovascular retrieval before the study. The filters were slanted and the proximal retrieval hooks penetrated the posterior lateral IVC wall in all patients on computed tomography. Demographic information, operation parameters, and complications were recorded and analyzed. All patients were followed up for at least 12 months. The procedure was successful in all patients. The median surgery time was 53.6 ± 12.7 min and the average blood loss was 45.0 ± 13.5 ml. No serious complication occurred during the patients' hospitalization, which was an average of 6.4 days. The median follow-up time was 15.1 months, and no patient had deep vein thrombosis recurrence. Retroperitoneal laparoscopic-assisted retrieval is a feasible and effective technique, particularly when proximal retrieval hooks penetrate the posterior lateral wall of the IVC after endovascular techniques have failed. To some extent, the development of this technique at our institution has increased the success rate of filter removal and improved patient satisfaction.

Modified Sling Technique for Difficult Filter Retrieval

Caval filters are placed in the inferior vena cava (IVC) to prevent pulmonary thromboembolism in patients with deep vein thrombosis. If there is no indication for thrombo-embolic risk prevention, the filter can be removed to reduce potential filter-related complications. Advanced endovascular techniques are frequently used to retrieve IVC filters. We describe an alternative filter-removal technique for use when standard techniques are not practicable. In our method, the filter hook is embedded within the IVC wall. To retrieve it, a long introducer is inserted; a guidewire and the "loop snare" retrieval system are then advanced through it with a coaxial system and positioned below the filter at the level of the common iliac vein confluence. The guidewire is then passed through the loop, creating a "sling" around the filter which allows the application of traction from the bottom upwards, releasing the hook from the wall. The loop is then held under tension with the filter aligned in the IVC lumen, and the introducer is advanced distally to completely cover the filter, allowing complete retrieval of the filter without damaging the vessel walls. This modified Sling technique is a safe and feasible method for complicated IVC filter retrieval.

Double inferior vena cava filter implantation in a patient with duplication of the inferior vena cava

An 84-year-old-woman was admitted because of syncope and dyspnea. She also required surgery for lumbar disc herniation. Computed tomography revealed bilateral massive pulmonary thromboembolism, deep vein thrombosis, and duplication of the inferior vena cava (IVC) in which the left IVC had merged with the left renal vein. Two retrievable IVC filters were deployed in both IVCs, and direct oral anticoagulant therapy was started. After orthopedic surgery for the lumbar disc herniation, the IVC filters were retrieved. No complications occurred. Different treatment strategies could be required for IVC filter implantation in a patient with duplication of the IVC.

Comparative efficacy and safety of the Captus device for inferior vena cava filter retrieval

PurposeRetrievable inferior vena cava filters (IVCF) have been increasingly used for mechanical pulmonary embolism prophylaxis since their development. The Captus Vascular Retrieval System (Avantec Vascular, Sunnyvale, California) is a new device developed for retrieval of IVCF. This study compared the safety and efficacy of the new Captus device against the existing EnSnare Endovascular Snare System (Merit Medical, South Jordan, Utah) for IVCF retrieval. MethodsPatients undergoing IVCF retrieval at a single institution between July 2015 and July 2020 were retrospectively identified. All adult patients (>18 years) undergoing filter retrieval with either Captus or Ensnare were included. Technical success and complications were compared by device. A complexity score was assigned to each case to adjust for selection bias. Logistic regression was used to model the association between device type and primary technical success. Results99 IVCF retrievals met inclusion criteria, 59 with Captus and 40 with Ensnare. The majority of the cohort consisted of low complexity cases (n = 51, 86% Captus versus n = 31, 78% Ensnare; p = 0.28). Technical success for low and medium complexity retrievals was 88% and 62% with Captus and 96% and 33% with Ensnare. There was no significant association between device type and technical success, adjusting for case complexity (Captus OR 0.55, 95% CI 0.08–2.72, p = 0.49). There were no device-related complications. ConclusionNo statistically significant difference in device technical success or complications between the Ensnare and Captus devices for uncomplicated IVCF retrieval. PrecisThe Captus Vascular Retrieval System is a new device for IVC filter retrieval which has similar technical success to the existing EnSnare.

Abstract No. 194 Follow through: increasing inferior vena cava filter retrieval rates at the community level

To evaluate the efficacy of various interventions at improving IVC filter retrieval rates. Secondary outcomes included whether a medium-sized community practice can achieve rates commensurate with larger academic centers

Abstract No. 535 Safety and efficacy of complex inferior vena cava filter retrievals: a systematic review

Abstract No. 535 Safety and efficacy of complex inferior vena cava filter retrievals: a systematic review

Abstract No. 528 Modeling socioeconomic and demographic variables affecting inferior vena cava filter placement and retrieval: a single-institution retrospective review at a safety net hospital from 2012 to 2019

This study was conducted to investigate the factors affecting IVC filter retrieval rates at a county hospital with the intent to supplement guidelines for IVC filter placement. We conducted a retrospective review of all patients who underwent IVC filter placement at our institution between January 2012 and December 2019. During the study period 539 patients had IVC filters placed; of those, 405 (148 women, 257 men, median age 51 years), had sufficient data and were over the age of 18. The following variables were collected: age, gender, BMI, ZIP code, marital status, insurance type, primary language spoken, length of hospital stay, indication type (classic, expanded, or prophylactic)1, presence of trauma, discharge destination (home, long-term nursing, or other), date of IVC filter retrieval (if applicable), and the presence of risk factors (smoking history, alcohol use, hypertension, diabetes, venous thromboembolism). The patients’ ZIP codes were used in conjunction with US census data on median household income by ZIP code to estimate their socioeconomic status (SES). SES was log transformed to correct for non-normality. Variables that showed a significant difference between those who had their IVC filters removed and those who did not were tested for inclusion in a multivariate logistic regression model. Inclusion criteria was based on statistical significance at α ≤ .05 for each independent variable. All insurance data were included as dummy variables in a set with “uninsured” as the reference category. Inclusion of these covariates in this model predicts 31.5% of the variation in IVC filter retrieval rate (Nagelkerke R-squared = .315). The Table displays the patient characteristics that statistically significantly contribute (α ≤ .05) to predicting IVC filter retrieval rates. Various patient characteristics including demographics, comorbidities, insurance coverage, and clinical indications are predictive of IVC filter retrieval rates. These must be considered when developing protocol on IVC filter placement indications at institutions with certain patient populations, such as a county hospital.Tabled 1Odds Ratio95% Confidence IntervalP Value Age0.980.97–0.99.011 Ln SES2.21.15–4.18.017 Trauma3.11.74–5.4.000 Diabetes0.310.15–0.63.001 VTE0.530.31–0.9.018Insurance Commercial or self-pay1.970.94–4.12.072 Medicaid2.11.0–4.3.049 Medicare1.10.43–2.6.921Model AUC0.80.76–0.85Nagelkerke R-squared0.315AUC = area under the receiver operating characteristic curve; SES = estimated median household income. *** Open table in a new tab

Abstract No. 80 Inferior vena cava filter placement and retrieval in pediatric patients: a multicenter retrospective analysis

Abstract No. 80 Inferior vena cava filter placement and retrieval in pediatric patients: a multicenter retrospective analysis

Abstract No. 104 National trends in inferior vena cava filter placement and retrieval: how are we doing?

Prior studies demonstrate a marked increase and subsequent decrease in the number of inferior vena cava (IVC) filters placed over the last several decades. The aim of this analysis was to evaluate national recent trends in placement and removal of IVC filters in the Medicare population using the most recent data available.

IVC filter retrieval: a multicenter proposal of two score systems to predict application of complex technique and procedural outcome.

Aim of this study was to identify preprocedural parameters, which may predict the application of a complex IVC filter retrieval technique and estimate the procedural outcome by applying two dedicated score systems. In this retrospective multicenter analysis, data concerning patient, filter and procedure characteristics were retrieved from January 2018 to March 2020. Patients were evaluated according to the retrieval technique (standard vs. complex) and the procedural outcome (success vs. failure). Significant differences among these groups were evaluated, and two score systems were developed to predict the application of a complex retrieval technique and the procedural outcome. One hundred and sixteen IVC filters were retrieved in 116 patients. In 98 subjects, the filter was retrieved with a standard procedure (Standard group, 84.5% vs. Complex group, 15.5%), while in 106 patients the procedure was successful (Success group, 91.4% vs. Failure group, 8.6%). Statistically significant differences were noted in terms of embedded filter hook, filter apex tilt, angle between filter axis and IVC, caval wall penetration, dwelling time and procedural time. Two score 0-5 points to predict the need for a complex retrieval technique and the procedural outcome were developed, with a prognostic accuracy of 88.8% and 91.4%, respectively. Significant differences were appreciable analyzing the sample data comparing both the retrieval technique applied and the procedural outcome. Two predictive scores were developed to assess the need for applying a complex retrieval technique and to estimate the procedural outcome.

Clinical evaluation of retrievable inferior vena cava filters for the prevention of pulmonary thromboembolism

Inferior vena cava filters (IVCFs) have been reported to cause chronic complications. Recently, retrievable IVCFs (r-IVCF) have been increasingly used to prevent acute pulmonary thromboembolism (PTE) and allow retrieval upon reduction of PTE risk. However, the outcomes of their use in Japan remain unknown. This study retrospectively investigated the acute PTE relapse prevention rate, IVCF retrieval attempt rate, retrieval success rate, and long-term prognosis of 197 patients who underwent r-IVCF insertion at our hospital between 2010 and 2018. Subjects had a mean age of 68years and a male-to-female ratio of 1:1. After r-IVCF insertion, the acute PTE prevention rate was 99.5%. The r-IVCF retrieval rate was 55% (108 patients), with a success rate of 99% (107 patients). r-IVCF retrieval was not attempted in 89 cases due to advanced cancer or poor prognosis (41%), loss to follow-up (32%), and long-term indwelling IVCF (17%). The retrieval group had an average observation period of 36months, with their anticoagulation therapy continuation, PTE recurrence, and deep vein thrombosis (DVT) recurrence rates being 64%, 3%, and 4%, respectively. The non-retrieval group had a mean observation period of 21months, with their anticoagulation continuation, PTE recurrence, and DVT recurrence rates being 78%, 3%, and 15%, respectively. DVT recurrence rates increased significantly in the non-retrieval group (p < 0.01). Moreover, 65% of all DVTs occurred centrally from the femoral veins, among which 9% were contraindicated for anticoagulation therapy. IVCF placement significantly prevented acute PTE but promoted recurrent DVTs when not retrieved after risk reduction. Hence, to increase recovery rates, IVCFs be promptly removed when no longer necessary.

Single center experience of inferior vena cava filter retrieval in trauma patients: contrast-enhanced CT-based retrieval within hospital stay

PurposeTo assess the safety and retrieval rate of a predischarge inferior vena cava (IVC) filter retrieval strategy based on contrast computed tomography (CT). MethodsIVC filter insertion for trauma patients from 2010 to 2018 were reviewed. An active filter retrieval strategy was established in March 2017. The strategy sought early evaluation of venous thromboembolism (VTE) status and filter retrieval before a patient's discharge. The possibility of early IVC filter retrieval was evaluated by a multidisciplinary team based on pre-filter retrieval VTE-CT findings. Overall VTE-CT findings, retrieval rate, indwelling time, and recurrence of venous thromboembolic events were compared before and after the filter retrieval strategy setup. Results177 IVC filters were inserted in trauma patients. All patients underwent pre-filter retrieval VTE-CT. VTE-CT findings were as follows: completely resolved VTE, n = 108 (61%); partially improved, n = 58 (33%); no change, n = 8 (5%); aggravated, n = 3 (2%). The overall retrieval rate was 84% with a mean indwelling time of 32 days. In subgroup analyses, 95 (53%) had filter retrieval with the before strategy (BS) setup and 82 (47%) with the after strategy (AS) setup. The retrieval rate was significantly higher in the AS group [81/82 (99%) vs. 68/95 (72%), (p < 0.001)]. No patients had recurrent VTE during the follow-up period. ConclusionsThe active strategy of VTE-CT-based filter retrieval during the hospital stay markedly improved the filter retrieval rate from 72% to 99% without evidence of recurrence of VTE. Hazards of low retrieval rate versus CT-related radiation exposure should be studied in the future.

Retrievable inferior vena cava filter to prevent pulmonary embolism in patients with fractures and deep venous thrombosis of lower extremities: a single-center experience.

ObjectiveTo evaluate the effectiveness of inserting a retrievable inferior vena cava filter (IVCF) to prevent pulmonary embolism (PE) in patients with bone fractures and acute deep venous thrombosis (DVT) before major orthopedic surgery.MethodsClinical data of patients with fractures and acute DVT who underwent IVCF insertion were analyzed. The patients were divided into above-knee DVT (AKDVT), popliteal vein thrombosis (PVT), and below-knee DVT (BKDVT) groups.ResultsAn IVCF was successfully implanted in 964 patients, among whom 929 were followed up (335, 470, and 124 in AKDVT, PVT, and BKDVT groups, respectively). There was no significant difference in the incidence of filter thrombosis among the groups (11.04%, 11.70%, and 8.06%, respectively). No symptomatic PE occurred during follow-up. The mean filter indwelling time was 18.4 ± 4.3 days, and the total filter removal rate was 76.87%. There was no significant difference in the rate of filter implantation, retrieval, complications, or mortality among the groups.ConclusionsRetrievable filters can effectively prevent PE before orthopedic surgery in patients with fractures and acute DVT of the lower limbs. AKDVT more readily forms a ≥1-cm thrombus in the IVCF than does BKDVT, and PVT more readily forms a <1-cm thrombus than does AKDVT.

Feasibility study of hand-carried ultrasound-guided retrievable inferior vena cava filter placement

BackgroundWith the development of ultrasonic diagnostic techniques in recent years, ultrasound-guided placement of inferior vena cava (IVC) filters has been widely used in clinics, and satisfactory results have been achieved. Our study aims to observe the accuracy of hand-carried ultrasound-guided retrievable vena cava filter placement, evaluate the feasibility and safety of this new method, and provide a scientific and effective interventional method and clinical data to prevent acute pulmonary embolism (PE) after battle injury of limbs.MethodsTwo hundred patients with post-traumatic thrombosis of the extremities were enrolled. The renal vein was located under the guidance of hand-carried ultrasound. The retrievable filter was fixed 1–2 cm below the opening of the renal vein. The self-expanding filter was used after the filter’s position was confirmed by injecting the contrast agent under the digital subtraction angiography (DSA) fluoroscopy.ResultsAll the 200 patients underwent the operation successfully. The position of the hand-carried ultrasound localizer was consistent with the DSA localizer. All the filters were expanded smoothly. No complications related to the operation occurred.ConclusionsThe study concluded that the hand-carried ultrasound-guided retrievable vena cava filter placement has a high success rate and can prevent acute PE after limbs’ battle injury.

The question of whether vena cava filters have a role in trauma patients remains unanswered.

SummaryWhether to temporarily place retrievable inferior vena cava filters for prophylaxis against pulmonary embolism in high-risk trauma patients has been a difficult question to answer. Guidelines regarding the management of these patients are mixed in their recommendations. The question merits further attention.

Evaluation of inferior vena cava filter placement during percutaneous endovenous intervention for proximal lower extremity deep venous thrombosis: a retrospective study

Background Anticoagulant therapy is still the prevalent treatment for venous thromboembolism. In the new era of percutaneous endovenous intervention, there is a progressive increase in the use of percutaneous endoluminal clot dissolution techniques such catheter-directed thrombolysis (CDT) and mechanical aspiration thrombectomy devices because of their short-term advantages. Prophylactic deployment of inferior vena cava (IVC) filter during percutaneous endovenous therapy for lower extremity deep venous thrombosis (DVT) is still a debatable issue. Objectives The aim of our study is to assess retrospectively the frequency of embolization and the need for deployment of a retrievable IVC filter during endovenous treatment of proximal lower extremity DVT using percutaneous CDT and AngioJet pharmacomechanical thrombectomy (PMT) techniques. Settings and design This was a retrospective study. Patients and methods Percutaneous endoluminal clot dissolution using either CDT or AngioJet PMT for proximal lower extremity DVT was performed on 56 patients (59 limbs) of 187 patients diagnosed with proximal acute/subacute DVT in the Vascular Surgery Department of the study hospitals. An IVC filter was deployed in 29 patients before or during the procedure. Results Of 56 patients who were treated for proximal DVT with clot debulking procedures, the IVC filter was prophylactically deployed in 26 (46.4%) patients. Trapped thrombus in the deployed filters as shown on venocavography was observed in 9/26 (34.6%) filters deployed prophylactically, with an overall rate of thrombus embolization during percutaneous endovenous thrombus dissolution techniques being 12/56 (21.4%) patients. Conclusion CDT could be performed safely and effectively without routine prophylactic IVC filter placement in the treatment of acute DVT. Selective filter placement may be considered in patients undergoing PMT or patients with more proximal thrombus patterns with multiple risk factors.

Impact of Advanced Technique on Improvement in the Retrievable Inferior Vena Cava Filter Retrieval Rate.

It is recommended to remove retrievable inferior vena cava filters (r-IVCFs) when they are no longer needed because their presence may give rise to serious complications related to prolonged placement of the filter. An advanced filter retrieval technique may help improve the retrieval rate. 107 consecutive patients (mean age; 61±18 years, male 53%) in whom r-IVCF retrieval was attempted were prospectively enrolled between April 2012 and December 2018. The frequently used advanced techniques were sling technique and biopsy forceps dissection technique. Retrieval success was 75% with standard retrieval technique alone; however, the overall retrieval success rate improved to 98% with advanced techniques. We observed few serious complications related to the retrieval procedure. Logistic multivariate analysis identified prolonged indwelling time (P=0.0011) and embedded hook in the caval wall (P=0.0114) as independent predictors, and the cutoff value for the indwelling time for requirement of advanced technique was 80 days. Advanced retrieval techniques helped improve the retrieval rate without serious complications. We may need to consider the referral of patients to centers with expertise in advanced retrieval techniques when the indwelling time is >80 days, and pre-retrieval CT image shows a hook embedded in the vessel wall.

May\u2013Thurner syndrome, a diagnosis to consider in young males with no risk factors: a case report and review of the literature

BackgroundMay–Thurner syndrome is an anatomical condition characterized by compression of the left common iliac vein by the right common iliac artery, causing venous outflow obstruction. It is an uncommon cause of deep vein thrombosis and is more prevalent among women. This paper highlights the importance of considering May–Thurner syndrome in young males without risk factors presenting with left lower limb pain, as endovascular treatment may be required.Case presentationA 23 year-old Caucasian male presented with a 1-week history of left lower limb pain, edema, and pallor. He was found to have an unprovoked deep vein thrombosis on Doppler ultrasound involving the left fibular, soleus, gastrocnemius, popliteal, femoral, common femoral, and external iliac veins. A heparin infusion was commenced as the initial treatment for deep vein thrombosis. Further investigation with computer tomography pulmonary angiogram and computer tomography venography of the abdomen and pelvis showed bilateral pulmonary emboli and left common iliac vein compression with left common, internal, and external iliac vein thrombosis. He was diagnosed with May–Thurner syndrome despite having no risk factors. A retrievable Cook Celect Platinum inferior vena cava filter was placed, and thrombus of the left common femoral, external, and common iliac veins was treated successfully with AngioJet thrombectomy, thrombolysis using 200,000 units of urokinase, angioplasty and stenting using two Cook Zilver Vena venous self-expanding stents. Therapeutic enoxaparin was commenced on discharge. His filter was removed after 10 weeks. Hematological follow-up 4 months later showed an overall negative thrombophilia screen, and anticoagulation was switched to apixaban. He has had no recurrent thrombosis.ConclusionsClinicians should have a low threshold to investigate for May-Thurner syndrome in patients with left lower limb venous thrombotic events regardless of risk factors, as endovascular treatment may be required to minimize the long-term sequelae of deep vein thrombosis. Duplex ultrasound can be used initially for diagnosis, and computer tomography venography used subsequently if the common iliac vein is not visualized on ultrasound. Endovascular treatment is preferred over anticoagulation alone, especially in otherwise fit patients presenting early, the aim being to reduce the chances of chronic venous hypertension in the lower limb.