Interventional treatment of venous thrombosis

Olivier H. for chronic lesion, i prefer anterograde approach through the femoral or popliteal. Some teams favor internal jugular approach (must always be ready in case of IVC lesions)
for acute lesions, it depends on the patency of the popliteal vein. If occluded, jugular or controlateral acess

Olivier H. PE does not change the strategy but can make discuss the use of an IVC filter

Olivier H. symptomatic and disabled patients C2-6, pelvic congestion syndrome

Peter N. I agree with Olivier, but wants to qualify it slightly. As we pointed out in the discussion, compression of the iliac veins are common in the asymptomatic population and possibly up to 30% have >50% stenosis with no symptoms! So there is a potential risk of overtreatment. In chronic venous disease of the lower limb, treatment of the outflow obstruction is indicated in patients with the C-class in CEAP being marked swelling (C3) and those with skin changes/ulcers (C4-C6). In addition, you have those patients with venous pain without skin changes or varicose veins, which can not be solely explained by the presence of reflux, if any. We use visual analogue scale (VAS) to evaluate that, considering VAS >5 being significant. As Olivier pointed out the symptoms have to affect the patients' quality of life.