This young adult male presented with symptoms and signs suggestive of arterial claudication. Interestingly, he did not have any lower limb swelling despite a chronic extensive lower limb DVT.
He reported non-compliance with his anticoagulation in the months preceding admission. He has a strong family history of venous thromboembolism; however, a negative thrombophilia screen. His past history included mild cerebral palsy; although, no known medical conditions to predispose him to thrombosis.
Due to the residual clot burden after thrombolysis and thrombectomy, the catheter sheath was left in-situ and the patient had an overnight infusion of urokinase and therapeutic heparin.
The following day he had a repeat ultrasound, which unfortunately showed recurrence of occlusive iliofemoral DVT. He underwent repeat catheter-directed thrombolysis and thrombectomy with a good result and no residual clot burden.
He did not have any signs, symptoms or imaging findings of pulmonary emboli.
He made a good recovery and was discharged home on therapeutic anticoagulation.