An alternative method of treatment is a surgical procedure called venous thrombectomy. This is the direct removal of blood clots from the vein. It is offered to patients who have refused thrombolysis, who have a contraindication to receiving thrombolytic drugs, or who have had an unsuccessful course of thrombolytic therapy. Examples of patients who cannot receive thrombolytic drugs are those who have active bleeding or who have a high risk for a bleeding complication and those who have had a recent eye operation or a recent major surgical operation.

For patients who are bedridden and those who are in very poor health, treatment with anticoagulation agents (blood-thinning agents) alone may be advisable.

According to recently published reports, patients treated early in their course of iliofemoral deep vein thrombosis with catheter-directed thrombolysis can expect an 80% success rate compared with 18% success in patients treated with conventional anticoagulation (agents taken to thin the blood). Generally, catheter-directed thrombolysis is the preferred treatment option for patients with iliofemoral deep venous thrombosis who have no contraindication to receiving a thrombolytic drug. Otherwise, venous thrombectomy is recommended. Successful and timely lysis of the blood clot results in less serious post-thrombotic symptoms and improved health-related quality of life.