Comparing Reintervention Factors in Acute Deep Vein Thrombosis and Post-Thrombotic Syndrome
Abstract
Background: Acute iliofemoral deep vein thrombosis (DVT) and post-thrombotic syndrome (PTS) are characterized by significant morbidity due to impaired venous drainage. Although technical success in endovascular interventions is increasing, the need for reintervention due to complications like stent thrombosis and restenosis remains the primary obstacle to long-term clinical success.
Objective: This study aims to compare clinical characteristics and intraoperative findings requiring reintervention in acute DVT and PTS patients to optimize patient-specific follow-up and management strategies.
Materials and Methods: We retrospectively evaluated 400 patients (184 Acute DVT, 216 PTS) who underwent iliofemoral venous stenting. A subgroup of 111 patients (51 Acute DVT, 60 PTS) undergoing reintervention for clinical or radiological failure was analyzed. Groups were statistically compared regarding demographics, reintervention indications, and intraoperative findings.
Results: The 12-month primary patency rates were 72.5% for Acute DVT and 68.3% for PTS. Among those requiring reintervention, the PTS group had significantly higher rates of recent surgery/trauma (53.3% vs. 27.5%; p=0.010) and recurrent venous ulcers (48.3% vs. 23.5%; p=0.012). Intraoperatively, in-stent restenosis (ISR) was more frequent in the PTS group (66.7% vs. 47.1%; p=0.038). In the Acute DVT group, masked anatomical issues predominated, specifically contralateral outflow obstruction (15.7% vs. 3.3%; p=0.042) and untreated additional venous lesions (47.1% vs. 23.3%; p=0.015). Secondary patency rates remained high in both groups (90.2% and 85.1%).
Conclusion: Reintervention etiologies for acute DVT and PTS differ significantly. Failure in PTS is associated with chronic ISR and ulcer recurrence, while missed anatomical lesions during the index procedure are decisive in acute DVT. Extensive anatomical mapping in acute cases and aggressive restenosis monitoring in PTS are critical for long-term success.
Keywords
deep vein thrombosis, post-thrombotic syndrome, reintervention, venous stenting, endovascular intervention
References
- Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123:1788–1830.
- Kahn SR, Shapiro S, Wells PS, et al. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet. 2014;383:880–888.
- Notten P, de Smet A, Tick LW, et al. CAVA (Ultrasound-Accelerated Catheter-Directed Thrombolysis on Preventing Post-Thrombotic Syndrome) trial: long-term follow-up results. J Am Heart Assoc. 2021;10:e018973.
- Kakkos SK, Gohel M, Baekgaard N, et al. European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg. 2021;61:9–82.
- Avgerinos ED, Hager ES, Naddaf A, et al. Outcomes and predictors of failure of thrombolysis for iliofemoral deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2015;3:35–41.
- Pouncey AL, Kahn T, Morris RI, et al. Risk factors and classification of reintervention following deep venous stenting for acute iliofemoral deep vein thrombosis. J Vasc Surg Venous Lymphat Disord. 2022;10(5):1051–1058.e3.
- Razavi MK, Jaff MR, Miller LE. Safety and effectiveness of stent placement for iliofemoral venous outflow obstruction: systematic review and meta-analysis. Circ Cardiovasc Interv. 2015;8:e002772.
- Bakas JM, Moelker A, van Montfrans C, et al. Long-term follow-up, causes for re-intervention, and consequences for surveillance after stenting for proximal deep vein obstruction. Eur J Vasc Endovasc Surg. 2023;66(3):389–396.
- Banerjee A, Benedetto V, Gichuru P, et al. Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study. Heart. 2020;106:119–126.