A rare cause of ilio-femoral deep vein thrombosis in young adults: asymptomatic chronic inferior vena cava occlusion

Introduction: Acute lower extremity deep venous thrombosis in young adults is usually related to thrombophilia, immobility, trauma, surgery or malignancy. Therapeutic options have recently included pharmacomechanical thrombus removal although there is no evidence of the indication or of the long-term benefit. Rarely unknown, asymptomatic chronic neonatal inferior vena cava occlusion could also lead to acute ilio-femoral thrombosis. Aim: The aim of the authors was to present the therapeutic possibilities in lower extremity deep venous thrombosis connected with chronic inferior vena cava occlusion. Method: In a retrospective single center study data of 21 adults were analyzed. Results: In 4 of the 21 patients chronic inferior vena cava obstruction was identified as an underlying cause of the acute thrombosis. Pharmacomechanical lysis was not offered to them and anticoagulation therapy was introduced. After an average 27.5 +/- 11 month follow-up all the patients were alive and no adverse event occurred. Conclusions: In patients with acute lower extremity deep venous thrombosis and chronic inferior vena cava occlusion the indication of the endovenous pharmacomechanical lysis therapy is questionable. The authors suggest to consider computed tomography angiography or magnetic resonance angiography in addition to duplex sonography in patients with no obvious risk factors for lower extremity deep venous thrombosis to avoid unnecessary invasive treatment.