The Role of Pharmacomechanical Endovascular Intervention for Iliofemoral Vein Thrombosis Compared to Conventional Anticoagulation Therapy

Abstract

Although anticoagulation therapy is the primary treatment for deep vein thrombosis (DVT), it has not been associated with the rapid recanalization of the venous occlusion. Moreover, it is associated with long-term disability due to post-thrombotic syndrome (PTS). In contrast, pharmacomechanical endovascular intervention (PMI) results in more rapid clinical improvement in DVT patients, but there are few reports on its long-term outcomes. This retrospective study evaluated the clinical effectiveness of PMI compared to conventional anticoagulation therapy (ACA) for acute and subacute iliofemoral DVT. We reviewed the medical records of 102 patients with iliofemoral DVT. A total of 46 patients for ACA and 56 patients for PMI were enrolled. We analyzed the clinical differences between the PMI and ACA groups by comparing the clinical signs, residual DVT free-rate, and PTS-free rate. There were no statistically significant differences in the demographic characteristics and risk factors except age between the groups (age: ACA, 52.0 ± 18.0 years; PMI, 59.0 ± 17.0 years; P = 0.035). The 1-, 3-, and 5-year residual DVT-free rate (ACA = 84.7%, 71.6%, and 46.0%; PMI = 82.1%, 76.8%, and 76.8%, respectively; P = 0.235) was not significantly different. However, the 1-, 3-, and 5-year PTS-free rate was significantly different (ACA = 93.5%, 74.0%, and 55.7%; PMI = 92.9%, 90.0%, and 90.0%, respectively; P = 0.019). There was no significant difference in the rate of other complications. PMI showed a lower incidence of PTS during the follow-up period. Therefore, PMI should be considered as an effective therapeutic modality for patients with iliofemoral DVT.

A systematic review on long-term clinical impact in patients with iliofemoral deep vein thrombosis

“…Ulcers were reported in 7 (5.5%) medically treated vs 5 interventionally treated patients (5%) vs 7 (5.5%). 16,18,19 Venous disability score and clinical score was reported in the study by Plate et al as shown in Table 3.…”

“…There were 233 eligible studies that were evaluated as full-text articles. After full-text assessment, 8 studies 12–19 were included in this systematic review. The flow diagram is shown in Figure 1.…”

“…In two studies, 12,19 the CEAP classification was described according to the consensus statement by the ad hoc committee of the American Venous Forum in 1994, 20 while in the study by Lindow et al, 17 the CEAP classification was described according to the revised statement in 2004. 6 Pulmonary embolism was reported in 11 (7.2%) medically treated patients 12,14,16 and in 1 (0.5%) interventionally treated patients. 12,14–17 The median Villalta score was reported only in one study.…”

Comparison of Treatment Result Between Anticoagulation Alone and Catheter-Directed Thrombolysis Plus Anticoagulation in Acute Lower Extremity Deep Vein Thrombosis

“…According to the thrombus removal rate and recurrence free rate, we did not find any significant differences of clinical importance between the CDT and ACA groups; however, evidence of more adverse events was noted in the CDT group. Although there were no deaths during hospitalization, four patients had active bleeding that required transfusion and bleeding control after CDT [1,24].…”

Gaps arising from randomized controlled trials on thrombolysis for proximal deep vein thrombosis of the lower limb

“…9,28 Additional long-term follow-up data were provided by observational analyses with a low level of evidence for which the exact period of surveillance was difficult to define and the application of objective tools in the assessment of symptoms was questioned. 9,[29][30][31] The low rate of CDT technical success in the CAVA trial resulted in further arguments regarding the need and usefulness of these comparative studies between CDT and anticoagulation therapy alone. The CAVA trial failed to prove that ultrasound-assisted thrombolysis is superior to CDT alone.…”