Peripheral thrombus extension is associated with increased risk of recurrent deep venous thrombosis in patients undergoing percutaneous thrombectomy for iliofemoral deep venous thrombosis

Objective

Patients presenting with iliofemoral deep venous thrombosis (DVT) often undergo percutaneous thrombectomy intending to prevent post-thrombotic syndrome. However, the relationship between the extent of DVT and outcomes after thrombectomy has not been explored. The objective of this study was to compare rates of post-thrombectomy DVT recurrence between patients with isolated iliofemoral DVT and patients with iliofemoral DVT and extension more peripherally.

Methods

We conducted a single-center, retrospective analysis of all patients who underwent thrombectomy for iliofemoral DVT from 2014 to 2023. Patients were stratified into two cohorts: (1) iliofemoral DVT without popliteal/tibial extension or (2) iliofemoral DVT with popliteal/tibial extension. The primary outcome was acute DVT recurrence and multivariable analysis was performed to identify risk factors for recurrence. The χ² test and t test were calculated for categorical and continuous data, respectively. Kaplan-Meier analysis was used to compare rates of acute DVT and chronic venous changes postoperatively. A P value of <.05 was considered statistically significant.

Results

We identified 222 patients during the study period (76 isolated iliofemoral DVT vs 146 iliofemoral DVT with peripheral extension) with a median follow-up of 19 months. Patients who presented with iliofemoral DVT with peripheral extension were more likely to be older (57 years vs 50 years; P = .004), have hypertension (64% vs 41%; P = .001) or hyperlipidemia (58% vs 40%; P = .01), and to have had surgery within the prior 6 months (29% vs 17%; P = .04). Among the female patients, those on hormone therapy were more likely to have isolated iliofemoral DVT (17% vs 3%; P < .001). Patients with iliofemoral DVT with peripheral extension had a greater chance of developing recurrent acute DVT (48% vs 20%; P < .001) and chronic venous changes (51% vs 30%; P = .004) during follow-up. Multivariable analysis showed a significant correlation between iliofemoral DVT with peripheral extension (odds ratio, 3.8; 95% confidence interval, 1.7-8.7; P = .001) and acute DVT recurrence. There were no differences in the rates of reintervention or death.

Conclusions

A more extensive peripheral thrombus burden was associated with higher rates of follow-up DVT recurrence in patients undergoing thrombectomy for iliofemoral DVT. These findings suggest that such patients may require closer follow-up and more aggressive anticoagulation therapy postoperatively. Moreover, our results provide a framework for further studies to specifically study the role peripheral thrombus may play in venous hemodynamics and the development of recurrent DVT and, ultimately, post-thrombotic syndrome.