Despite recent innovations in clot lysis technology, management of acute iliofemoral Deep Vein Thrombosis (DVT) remains a challenge worldwide. Long-term complications of proximal DVT include Postthrombotic Syndrome (PTS), which is characterized by chronic limb heaviness, pain, swelling, paraesthesia, pruritis and pigmentation changes . PTS affects between 23-43% of patients and has been shown to have a significant negative impact on quality of life and a large economic burden on the wider community. Early active treatment to remove thrombus has been shown to result in better outcomes, including lower rates of venous valve dysfunction , recurrent DVT and PTS .The management of acute iliofemoral deep vein thrombosis is constantly evolving. Clot removal techniques, such as surgical thrombectomy and thrombolysis, have been shown to be superior to anticoagulation therapy alone, resulting in decreasing rates of postthrombotic syndrome and DVT recurrence. Nonetheless, there is still a considerable disease burden in the community. In the search for better patient outcomes, we revisit the work of a previous generation of vascular surgeons who created a temporary AVF in combination with a surgical thrombectomy to promote blood flow through the newly re-vascularized vessel. A number of small studies support their work, presenting consistently positive results. We propose that a temporary AVF could be beneficial when used in combination with anticoagulation therapy and CDT or PMCT. A temporary AVF is a simple technique to perform with minimal risk to the patient, and great potential to prevent re-thrombosis and PTS. We believe further investigation is warranted to test this hypothesis.
Last date updated on March, 2021