Factors Associated with Symptom Resolution Following Treatment of Iliofemoral Deep Vein Thrombosis

Purpose: Management of complex deep venous pathology is rapidly expanding. As knowledge, technique, and technologies emerge, so will approaches to successfully treating these conditions. The purpose of this study was to determine factors associated with symptom resolution after intervention for acute or subacute iliofemoral deep vein thrombus (DVT).

Materials and Methods: This study was a single-institution, retrospective review of all patients who received treatment for iliocaval system DVT from 2010 to 2018. Information on patients’ demographics, treatment characteristics, medical management, and postprocedural surveillance were collected. Data were stratified by patient symptom resolution (complete, partial, none) at the time of discharge and the first postoperative follow-up visit (within 1–3 months of the procedure). Single-variate analyses comparing continuous variables used the t-test, and those comparing categorical variables used the chi-square test.

Results: Of the 70 interventions performed between 2010 and 2018 with recorded symptom resolution data, 15 (21.4%) participants had no symptom relief, 31 (44.3%) had partial symptom resolution, and 24 (34.3%) had complete resolution of symptoms at discharge or first follow-up. Higher percentages of complete and partial symptom resolution versus no symptom resolution were found with the use of intravascular ultrasound (IVUS) during the intervention (88% complete, 65% partial, 35% no resolution; P<0.01), placing stents (94%, 60%, 50%, respectively; P = 0.03), extending stents into the external iliac veins (75%, 50%, 25%, P = 0.03), and treatment with anticoagulation and antiplatelet (62%, 29%, 33%; P =0 .03). The use of direct oral anticoagulants after intervention was significantly associated with higher rates of no symptom resolution (33%, 19%, 67%; P<0.01).

Conclusions: Outcomes associated with intervention for acute iliofemoral DVT are dependent on multiple factors. Our study reinforces the importance of IVUS, as well as stenting of culprit lesions after clearance of acute thrombosis. We found extending stents into the external iliac veins to be associated with improvement in outcomes. This likely reflects the importance of identifying and treating inflow lesions after treating outflow lesions. Additionally, choice of anticoagulant after intervention also appears to have an association with symptom resolution. Further studies are needed to guide optimal technique and medical therapy.