The current treatment strategy for acute deep vein thrombosis (DVT) largely remains systemic anticoagulation to prevent worsening of acute symptoms, pulmonary embolism, and recurrent thromboembolic events. However, conservative therapy with anticoagulation alone is rarely efficient or sufficient in reducing clot burden to prevent postthrombotic syndrome, particularly in iliofemoral systems. Endovascular interventions, on the other hand, provide the capability of rapidly reestablishing patency of the affected veins, potentially preventing postthrombotic complications, and timely revealing an inciting venous defect in patients with acute DVT. Clinical diagnosis of DVT alone is unreliable due to only 50% of patients with evidence of DVT on venography having clinical symptoms. Venous duplex ultrasound, as the primary imaging technique, is extremely useful. Spectral Doppler can detect the presence of thrombus by determining normal or abnormal flow in the vessels. Normal Doppler will be unidirectional and spontaneous with respiratory phasicity. Flow should cease with Valsalva maneuver and demonstrate augmentation by distal compression. The most reliable method for detecting thrombus is compression. Compressions are done in gray scale in a transverse plane. The thrombus can only be ruled out when vessel walls completely collapse. Partial thrombosis may be present if the entire vein does not collapse.
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