Acute iliofemoral deep venous thrombosis in adolescents and young adults is associated with hypercoagulable states and a significant incidence of post-thrombotic syndrome.

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.