Quickshot: Acute Iliofemoral Deep Venous Thrombosis in Adolescents and Young Adults Is Unprovoked, Associated with Hypercoagulable States, and Has a High Incidence of Post-Thrombotic Syndrome

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 with reluctance to employ stents in this population. The purpose of this study is to review the etiology, the incidence of post-thrombotic syndrome (PTS), and 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:                  86 patients under age 25 were identified with acute IFDVT. 55 (64%) were female. 50 patients (58.1%) identified as white, 24 (28%) as black and 8 (9.3%) as Hispanic. The primary etiology of IFDVT was found to be multisystem trauma and/or sepsis in 27 (31.4%), cancer in 5 (5.8%) and COVID infection in 5 (5.8%). None of these patients were treated with interventional therapy. The remaining 49 cases occurred in patients who were previously healthy with no specific precipitating event (unprovoked group). 81% of this group were female and hypercoagulable states were identified in 25 patients (51%). Other risk factors in this group are listed in Table 1. Intervention was performed in 36 (73.5%) in the provoked group which consisted of pharmaco-mechanical thrombectomy (PMT) with balloon angioplasty in 22 patients and with stent insertion 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 iliofemoral DVT occurred in 18% of patients at 1 year and 26.2% at 3 years after IFDVT.

Conclusions:

Acute IFDVT in young patients is most often unprovoked, typically in females, with the majority of whom are found to have a hypercoagulable state. Most of this cohort were treated without venous stenting. 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 a focused study in larger cohorts is required to improve treatment recommendations.