Massive iliofemoral thrombosis in an 18-year-old man treated with an endovascular procedure

Introduction
Venous thromboembolism remains a widespread global problem that occurs not only in elderly patients but also in younger individuals. Most patients receive conservative treatment for deep vein thrombosis (DVT), but 20–50% of them will develop post-thrombotic syndrome as a consequence.

Material and methods
An 18-year-old man was admitted to the hospital with massive swelling and pain of the left leg. After a primary diagnostic process, computed tomography phlebography was performed, which revealed no contrast in the common iliac vein, external iliac vein, internal iliac vein, femoral vein, and great saphenous vein on the left side. The diagnosis of DVT was stated. Additionally, compression of the right common iliac artery on left iliac vein was visualized, which indicated May-Thurner syndrome.

Results
Mechanical thrombectomy was performed using the AngioJet system. Additionally, local thrombolysis was performed. For better outflow from the iliac vein, stent implantation was performed using a Bentley Beyond Venous 16 × 100 mm stent. Due to a rupture of the venous stent, an additional Sinus-XL 16 × 60 mm stent and a Sinus Venous 14 × 60 mm stent were implanted. Control phlebography was performed, and procedure was ended by leaving the 6F sheath in the popliteal vein with administration of Actilyse for 24 hours. Venography performed on the next day revealed an optimal result with very good outflow. What is more, the patient reported pain relief, and the leg swelling decreased.

Conclusions
Endovascular recanalization of the iliofemoral vein thrombosis is technically possible, safe, and durable.