Lombardi Megan, Glass Julia, Wasan Suman, Marston William
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.
East Carolina Brody School of Medicine, Greenville, NC.
J Vasc Surg Venous Lymphat Disord. 2025 Feb 11;13(4):102211. doi: 10.1016/j.jvsv.2025.102211.
Acute iliofemoral deep vein thrombosis (IFDVT) in young adults and adolescents is a cause of lower extremity pain and edema that may lead to chronic debilitating symptoms. Treatment options include pharmaco-mechanical thrombectomy, stent placement, and anticoagulation. The lack of long-term data in young patients after venous stenting leads to variability in treatment and reluctance to employ stents in this population. The purpose of this study is to review the etiology and incidence of post-thrombotic syndrome (PTS) along with the role of intervention in young patients after IFDVT.
Patients presenting with acute IFDVT were identified retrospectively through Peripheral Vascular Lab databases. IFDVT was defined as any thrombus believed to be <1 month old involving the common femoral or more proximal veins. Charts were reviewed to identify demographics, risk factors for venous thrombosis, relevant laboratory data, treatment provided for the DVT, and patient outcomes.
Forty-nine patients under age 25 were identified with acute IFDVT and no other acute illness or trauma precipitating thrombosis. Forty patients (81%) were female. Thirty-three patients (58.1%) identified as White, 10 (28%) as Black and five (9.3%) as Hispanic. Hypercoagulable states were identified in 25 patients (51%) with Factor V deficiency (9 patients) and antiphospholipid antibodies (6 patients) being the most common. Intervention was performed in 36 patients (73.5%), which consisted of pharmaco-mechanical thrombectomy with balloon angioplasty in 22 patients and with stent placement in 14. One year after IFDVT, 19 patients (43.2%) reported no PTS symptoms, 10 (22.7%) reported mild symptoms, and 15 (34.1%) reported moderate or severe symptoms. Recurrent IFDVT occurred in 18% of patients at 1 year and 26.2% at 3 years after IFDVT.
Acute IFDVT in young patients occurs typically in females, the majority of whom are found to have a hypercoagulable state. Most of this cohort were treated without venous stenting. However, significant PTS and recurrent IFDVT occurred frequently after the initial event, suggesting that aggressive treatment is warranted. This is an understudied patient population in whom the role of intervention and stenting is unclear, suggesting that focused study in larger cohorts is required to improve treatment recommendations.
青年人和青少年的急性髂股深静脉血栓形成（IFDVT）是下肢疼痛和水肿的一个原因，可能导致慢性衰弱症状。治疗选择包括药物机械性血栓切除术、支架置入和抗凝治疗。静脉支架置入术后年轻患者缺乏长期数据，导致治疗存在差异，且不愿在该人群中使用支架。本研究的目的是回顾血栓形成后综合征（PTS）的病因和发病率，以及IFDVT后干预措施在年轻患者中的作用。
通过外周血管实验室数据库对出现急性IFDVT的患者进行回顾性识别。IFDVT被定义为任何被认为小于1个月的血栓，累及股总静脉或更近端的静脉。查阅病历以确定人口统计学资料、静脉血栓形成的危险因素、相关实验室数据、DVT的治疗方法以及患者的预后。
确定49例25岁以下的急性IFDVT患者，且无其他急性疾病或创伤引发血栓形成。40例（81%）为女性。33例（58.1%）为白人，10例（28%）为黑人，5例（9.3%）为西班牙裔。25例（51%）患者存在高凝状态，其中最常见的是因子V缺乏（9例）和抗磷脂抗体（6例）。36例（73.5%）患者接受了干预，其中22例患者接受了药物机械性血栓切除术加球囊血管成形术，14例接受了支架置入术。IFDVT发生1年后，19例（43.2%）患者报告无PTS症状，10例（22.7%）报告有轻度症状，15例（34.1%）报告有中度或重度症状。IFDVT发生1年时，18%的患者出现复发性IFDVT，3年时为26.2%。
年轻患者的急性IFDVT通常发生在女性中，其中大多数被发现存在高凝状态。该队列中的大多数患者未接受静脉支架置入术治疗。然而，在初次发病后，PTS和复发性IFDVT频繁发生，这表明需要积极治疗。这是一个研究不足的患者群体，干预和支架置入的作用尚不清楚，这表明需要在更大的队列中进行针对性研究，以改进治疗建议。
