Management of Ilio-Femoral Deep Vein Thrombosis: A Hybrid Approach

Despite recent innovations in clot lysis technology, management of acute ilio-femoral Deep Vein Thrombosis (DVT) remains a challenge worldwide. We revisit the work of a previous generation of vascular surgeons who created a temporary Arteriovenous Fistula (AVF) in combination with a surgical thrombectomy, to maximize blood flow through the newly revascularized vessel. Since this time, surgical thrombectomy along with the use of a temporary AVF, has been superseded by endovascular techniques: namely Catheter-Directed Thrombolysis (CDT) and Pharmacomechanical Thrombolysis (PMCT). We review the evolution of the management of ilio-femoral deep vein thrombosis, specifically examining the trials which investigate temporary AVF with surgical thrombectomy. Furthermore, we describe the surgical technique of creating a temporary AVF, including how to avoid venous hypertension and how to facilitate closure if required. Finally, in the age of hybrid techniques, we propose that a temporary AVF could be used in combination with current thrombus removal techniques to possibly lower the risk of recurrent thrombosis and complications such as post-thrombotic syndrome.