Treating cancer patients with venous thromboembolism (VTE) is challenging due to the need to balance the benefits of percutaneous interventions against complication risks. Both bleeding complications and VTE are prevalent in cancer patients, with reported overall VTE annual incidences ranging between 0.5-20%, with certain malignancies having higher risks of bleeding for VTE.1Medical management with anticoagulation is typically first line treatment for VTE, this therapy may not be used in the cancer patient population because of concerns of bleeding complications. While there are ongoing studies looking at the effectiveness, safety, and comparative performance of anticoagulation therapy regarding outcomes in cancer patients, not all malignancy types are included in these studies. Thus, many providers are hesitant to prescribe anticoagulation to these patients.2 Minimally invasive treatment options including catheter directed thrombolysis (CDT) or percutaneous mechanical thrombectomy (PMT) and venous reconstruction can be beneficial to patients who are unable to receive anticoagulation. As there are currently no specific guidelines in this patient population, the interventional procedure used must be individualized based upon the type of malignancy, the expected life expectancy, anatomic location of the thrombus, and whether the thrombus contains tumor.3

Thrombus may be seen in the superior vena cava (SVC), as in patients with pulmonary malignancy/mediastinal lymphadenopathy which may result in SVC syndrome, the inferior vena cava (IVC) and/or iliofemoral venous system, resulting from extrinsic compression or direct malignant invasion, or in the portal-mesenteric system related to post-operative stenoses, or direct invasion or extrinsic compression from primary malignancies such as pancreatic adenocarcinoma. This review will focus on the evaluation of cancer patients with VTE involving the IVC and iliofemoral regions and the treatment options available in this patient population.