The current role of operative venous thrombectomy in deep vein thrombosis.

Patients with acute iliofemoral deep vein thrombosis suffer the most severe post-thrombotic sequelae. The pathophysiology of the post-thrombotic syndrome is ambulatory venous hypertension, and patients with valve dysfunction and luminal obstruction have the highest ambulatory venous pressures. Treatment designed to reduce or eliminate the post-thrombotic syndrome must necessarily remove thrombus to eliminate obstruction. The technique of contemporary venous thrombectomy follows basic vascular surgical principles and offers patients the opportunity for complete or near complete thrombus extraction. The techniques described herein represent the authors' approach to patients with few alternatives to clear their venous system.