Thrombectomy and arteriovenous fistula for iliofemoral venous thrombosis in fertile women.

Thirteen women of fertile age with left-sided iliofemoral venous thrombosis were treated with thrombectomy and a temporary arteriovenous fistula in the groin. In nine patients, the appearance of thrombosis could be related to pregnancy; in three of these, obstetric complications occurred. Diagnosis was obtained by antegrade and retrograde phlebography. After three months, the arteriovenous fistula was closed. Anticoagulant treatment was given from the time of diagnosis and for a total of six months. Patency of the iliac vein was determined by phlebography or venous occlusion plethysmography, or both. Based upon these findings, a short term patency rate of 85 per cent was achieved. Analysis of the material indicates a multifactorial pathogenic mechanism in the development of iliofemoral venous thrombosis. Important factors are pregnancy, obstetric complications, mechanical factors causing flow resistance in the iliac vein, hormonal factors and defective fibrinolysis.