Endovascular treatment of iliofemoral deep venous thrombosis: is there enough evidence to support it? A systematic review with meta-analysis

Abstract

Introduction: Post-thrombotic syndrome (PTS) and iliofemoral (IF) patency reduction are common complications of iliofemoral deep venous thrombosis (IFDVT). Recent studies suggested that endovascular treatment, such as catheter-directed thrombolysis (CDT) and pharmacomechanical thrombectomy (PMT) can effectively reduce the risk and morbidity of PTS in IFDVT patients. This article aims to review the current literature on the subject, focusing on the long-term outcomes of endovascular treatment techniques in IFDVT patients. Evidence acquisition: A thorough systematic review of the literature was conducted using PubMed/Medline and Scopus, according to PRISMA statement guidelines. Forty articles were included, according to their scientific relevance, for the qualitative analysis. From this initial set of articles, nine articles were included for the quantitative analysis. Evidence synthesis: Endovascular treatment with CDT or PMT is related to a decreased risk of PTS development, when compared to standard anticoagulation treatment (OR=0.71; 95% CI=0.54-0.92). Furthermore, IF patency presents superior rates in patients treated with CDT or PMT, instead of anticoagulation (OR=3.20; 95% CI=1.80-5.71). There are no significant differences in the risk of PTS and IF patency between patients treated with CDT and PMT. Complications such as bleeding, pulmonary embolism and death, don't seem to differ between endovascular treatment and anticoagulation, as well as between CDT and PMT procedures. Conclusions: Endovascular techniques seem to have satisfactory long-term outcomes in IFDVT, regarding to PTS risk and IF patency. However, further investigation with prospective randomized clinical trials with large populations and long follow-ups is necessary.

Which one is the best in Treating Deep Venous Thrombosis —— Percutaneous Mechanical Thrombectomy, Catheter-Directed Thrombolysis or Combination of them?

“…Due to different treatments, a signi cant proportion of DVT patients will have venous insu ciency. Compared with conventional anticoagulation therapy, thrombolytic therapy can rapidly reduce thrombus burden [4] , potentially preserve venous vascular function and reduce the risk of PTS [21] . Improvement of endovascular techniques makes it possible to use more approaches to increase success rate on DVT patients.…”

Citrullinated fibrinogen forms densely packed clots with decreased permeability

“… 3 The lytic pattern in altered thrombus structure might influence their propensity toward embolization 4 , 5 , 6 as well as the success of catheter‐directed thrombolysis and pharmacomechanical thrombectomy. 7 , 8 , 9 , 10 …”

“…3 The lytic pattern in altered thrombus structure might influence their propensity toward embolization [4][5][6] as well as the success of catheter-directed thrombolysis and pharmacomechanical thrombectomy. [7][8][9][10] Consequently, post-translational modifications of fibrin(ogen) (oxidation, glyoxylation, carbamylation, glycation) might have a crucial impact on clot stability through the alteration of fibrin structure. 2,[11][12][13] Citrullination is another post-translational modification potentially converting 23 peptidyl-arginyl residues of fibrinogen into peptidyl-citrulline.…”