iliofemorale tiefe Venenthrombose

Iliofemoral deep vein thrombosis (DVT) occurs when a thrombus in the iliac vein (common, external or internal) and/or common femoral vein obstructs the venous outflow from the lower limb leading to marked edema. DVT of the IVC or the more distal lower limb veins may also be present.

Terminology

Deep vein thrombus of the lower limb deep venous system distal to the common femoral vein is termed distal, femoropopliteal or infrainguinal DVT .

Epidemiology

Iliofemoral deep vein thrombosis accounts for ~25% of all cases of DVT.

Clinical presentation

Clinical presentation may be identical to that of a distal DVT i.e. lower limb swelling and pain. However, as patients with iliofemoral deep vein thrombosis are at clear risk of lower limb ischemia, phlegmasia cerulea dolens needs to be excluded as it can be limb- or life-threatening. Findings for this entity may include severe lower limb pain, gross edema, cyanosis, pulselessness, blistering of the skin, and eventual gangrene .

Radiographic appearance

Ultrasound

Ultrasonography with Doppler is generally the first-line imaging modality for assessing lower limb DVT with high sensitivity (95%) and specificity (96%) . This equally applies to DVT of the common femoral veins as for the more distal deep venous system.

However, the diagnosis of DVT of the pelvic veins can be very difficult, if not impossible, with ultrasound, due to multiple factors including bowel gas, large body habitus, normal anatomic depth of the vessels and abdominal pain. Iliac and IVC thrombosis will often require CT and/or MRI.

CT/MRI

CT venography and/or MR venography of the pelvis may be required to evaluate the pelvic veins for DVT.

Angiography (DSA)

Diagnostic catheter venography is rarely performed nowadays .

Treatment and prognosis

Generally, iliofemoral deep vein thrombosis is treated with anticoagulation much like regular deep vein thrombosis; however, they have very poor spontaneous recanalization rates (30%), cf. femoral DVTs (70%).

Recurrent DVT is more common with iliofemoral than femoropopliteal DVT.

The majority of cases of severe post-thrombotic syndrome are associated with poorly-recanalized iliac veins. 80% of patients with iliofemoral deep vein thrombosis have underlying venous stenosis proximally such as May-Thurner syndrome.

It is important to identify iliofemoral deep vein thrombosis as there is a role for catheter-directed thrombolysis +/- thrombectomy .

Siehe auch:

• Vena cava inferior Thrombose
• tiefe Venenthrombose