Endovascular Treatment Outcomes in Acute and Subacute Deep Vein Thrombosis: A Single-Center Experience

Öz

Objective: The aim of this study was to evaluate technical and clinical success rates, procedure-related complications, and recurrence rates during follow-up in patients with acute and subacute deep vein thrombosis (DVT) who underwent endovascular treatment. Material and Methods: In this retrospective, single-center study, patients aged ≥18 years who underwent endovascular treatment for acute or subacute DVT were included. Cases of isolated distal DVT and chronic DVT were excluded. Patient demographics, thrombosis location, endovascular treatment modality, use of thrombolytic agents, inferior vena cava filter placement, and stent deployment were recorded. Technical success was defined as achieving complete or clinically meaningful recanalization in the target venous segment. Clinical success was assessed based on marked improvement in limb pain and edema. Results: A total of 18 patients were included. The mean age was 48.3±15.1 years, and 66.7% were female. Concomitant pulmonary embolism was detected in 4 patients (22.2%). The mean symptom duration was 15.7±8.6 days. Ultrasound-assisted catheter-directed thrombolysis was performed in 66.6% of patients, thrombolysis via a multi-side-hole infusion catheter in 27.8%, and mechanical aspiration in 5.6%. Thrombolytic therapy was used in 17 patients overall. After endovascular intervention, complete recanalization was achieved in 55.6% and partial recanalization in 44.4%. The clinical success rate was 94.4%. During a mean follow-up of 13.2±6.2 months, no recurrence was observed in the treated limb. No major complications occurred; minor complications developed in 2 patients (11.1%). Conclusion: In selected patients with acute and subacute DVT—particularly involving the iliofemoral segment—endovascular treatment appears to be an effective and safe therapeutic option, with high technical and clinical success rates and an acceptable complication profile.

Anahtar Kelimeler

• Deep vein thrombosis
• tissue plasminogen activator
• endovascular procedures
• mechanical thrombolysis
• ultrasonography

AKUT VE SUBAKUT DERİN VEN TROMBOZUNDA ENDOVASKÜLER TEDAVİ SONUÇLARI: TEK MERKEZ DENEYİMİ

Öz

Amaç: Bu çalışmanın amacı, akut ve subakut derin ven trombozu (DVT) tanısı ile endovasküler tedavi uygulanan hastalarda teknik ve klinik başarı oranlarını, işlemle ilişkili komplikasyonları ve takip süresince gelişen rekürrens oranlarını değerlendirmektir. Gereç ve Yöntemler: Bu retrospektif, tek merkezli çalışmaya akut ve subakut DVT tanısı ile endovasküler tedavi uygulanan ve yaşı ≥18 olan hastalar dâhil edildi. İzole distal ve kronik DVT olguları çalışma dışı bırakıldı. Hastaların demografik özellikleri, tromboz lokalizasyonu, uygulanan endovasküler tedavi yöntemi, trombolitik ajan kullanımı, vena kava filtresi yerleştirilmesi ve stentleme durumu kaydedildi. Teknik başarı, hedef ven segmentinde tam veya anlamlı rekanalizasyon sağlanması olarak tanımlandı. Klinik başarı ise, ekstremite ağrısı ve ödeminde belirgin gerileme ile değerlendirildi. Bulgular: Çalışmaya toplam 18 hasta dâhil edildi. Hastaların yaş ortalaması 48,3±15,1 yıl olup, %66,7’si kadındı. Dört hastada (%22,2) eşlik eden pulmoner emboli saptandı. Ortalama semptom süresi 15,7±8,6 gün idi. Hastaların %66,6’sına ultrason destekli kateter yönlendirmeli tromboliz, %27,8’ine çok delikli infüzyon kateteri ile tromboliz ve %5,6’sına mekanik aspirasyon uygulandı. Toplam 17 hastada trombolitik tedavi kullanıldı. Endovasküler girişim sonrası %55,6 oranında tam, %44,4 oranında parsiyel rekanalizasyon sağlandı. Klinik başarı oranı %94,4 idi. Ortalama 13,2±6,2 aylık takip süresince işlem uygulanan ekstremitede rekürrens izlenmedi. Majör komplikasyon saptanmazken, iki hastada (%11,1) minör komplikasyon gelişti. Sonuç:Akut ve subakut, özellikle iliofemoral segmenti tutan DVT olgularında endovasküler tedavi, seçilmiş hastalarda yüksek teknik ve klinik başarı oranları ve kabul edilebilir komplikasyon profili ile etkili ve güvenli bir tedavi seçeneğidir.

Anahtar Kelimeler

• Derin ven trombozu
• doku plazminojen aktivatörü
• endovasküler prosedürler
• mekanik tromboliz
• ultrason

Kaynakça

1. Saricaoglu MC, Hasde AI, Karacuha AF, et al. Catheter-Directed Thrombolysis vs. Anticoagulation in Deep Vein Thrombosis: A Comparative Study. J Clin Med. 2025;14(10):3298.
2. Ochoa Chaar CI, Aurshina A. Endovascular and Open Surgery for Deep Vein Thrombosis. Clin Chest Med. W.B. Saunders. 2018;39(3):631-644.
3. Pernès JM, Auguste M, Kovarski S, Borie H, Renaudin JM, Coppe G. Acute deep vein thrombosis and endovascular techniques: It is time for a new aggiornamento! Diagn Interv Imaging. Elsevier Masson SAS. 2012;93(10):725-733.
4. Khalid MU, Singh M, Lakhter V, Bashir R. Catheter directed thrombolysis for deep vein thrombosis in 2022: Rationale, evidence base and future directions. Int J Cardiol. 2022;362:168-173.
5. Goldhaber SZ, Magnuson EA, Chinnakondepalli KM, Cohen DJ, Vedantham S. Catheter-directed thrombolysis for deep vein thrombosis: 2021 update. Vascular Medicine (United Kingdom). 2021;26(6):662-669.
6. Kim KA, Choi SY, Kim R. Endovascular Treatment for Lower Extremity Deep Vein Thrombosis: An Overview. Korean J Radiol. NLM (Medline). 2021;22(6):931-943.
7. Michael K. W. Lichtenberg, Stefan Stahlhoff, Katarzyna Młyńczak, et al. Endovascular mechanical thrombectomy versus thrombolysis in patients with iliofemoral deep vein thrombosis - a systematic review and meta-analysis. Vasa - European Journal of Vascular Medicine. 2021;50(1):59-67.
8. Shah KJ, Roy TL. Catheter-Directed Interventions for the Treatment of Lower Extremity Deep Vein Thrombosis. MDPI. 2022;12(12):1984.

9. Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH. Vascular and Interventional Radiology Catheter-Directed Thrombolysis for Lower Extremity Deep Venous Thrombosis: Report of a National Multicenter Registry 1. Vol 211. 1999.
10. Sharifi M, Bay C, Mehdipour ; Mahshid, Sharifi J. Thrombus Obliteration by Rapid Percutaneous Endovenous Intervention in Deep Venous Occlusion (TORPEDO) Trial: Midterm Results. Vol 19. 2012. www.jevt.org
11. Engelberger RP, Spirk D, Willenberg T, et al. Ultrasound-Assisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis. Circ Cardiovasc Interv. 2015;8(1):e002027.
12. Li W, Zaid Al-Kaylani A, Zeebregts CJ, et al. Effectiveness and safety of catheter-directed thrombolysis in conjunction with percutaneous mechanical thrombectomy for acute iliofemoral deep vein thrombosis: A meta-analysis. J Vasc Surg Venous Lymphat Disord. Elsevier Inc. 2023;11(4):843-853.e2.
13. Weinberg I, Vedantham S, Salter A, et al. Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial. Vascular Medicine (United Kingdom). 2019;24(5):442-451.
14. Kahn SR, Julian JA, Kearon C, et al. Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2020;8(1):8-23.e18.
15. Sandset M, Enden T, Haig Y, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. www.thelancet.com. 2012;379.
16. Schlager O, Campello E, Madaric J, et al. 2025 ESVM Guidelines on interventional treatment of venous thromboembolism. Vasa - European Journal of Vascular Medicine. Published online 2025.
17. Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.
18. Akhtar OS, Lakhter V, Zack CJ, et al. Contemporary Trends and Comparative Outcomes With Adjunctive Inferior Vena Cava Filter Placement in Patients Undergoing Catheter-Directed Thrombolysis for Deep Vein Thrombosis in the United States: Insights From the National Inpatient Sample. JACC Cardiovasc Interv. 2018;11(14):1390-1397.
19. Notten P, de Smet AAEA, 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(11):e018973.