Postthrombotic syndrome (PTS) is characterized by persistent leg edema, discoloration, pain, and ulceration in patients with a history of a deep vein thrombosis (DVT). We describe a 60-year-old man who had unilateral PTS develop from an iliofemoral DVT. The patient was treated with thrombolytic therapy using reteplase (Retavase, Centocor, Malvern, PA) followed by mechanical thrombectomy. Percutaneous transluminal angioplasty of the common and external iliac veins was subsequently performed, and a total of six self-expanding nitinol stents were deployed. Stent patency was assessed using an Advanced Technology Laboratories HDI 5000 (Philips Ultrasound, Bothell, WA) ultrasound machine with a curved 5-2 MHz transducer. B-mode images and color duplex ultrasonography with Doppler signals were recorded. Intraluminal echoes and the lack of vein compressibility confirmed the presence of remote thrombus more distally. However, widely patent stents with spontaneous, phasic blood flow were demonstrated in the common and external iliac veins. The patient's edema significantly improved. Deployment of stents to maintain vessel patency of diseased iliac veins is being performed with increasing frequency. Duplex ultrasonography is an inexpensive, noninvasive modality that can be used to follow patients who have had an endovascular venous intervention.
S. Begelman, Sandra L. Yesenko
Journal for Vascular Ultrasound