Post Thrombotic Syndrome Morbidity in Mechanical Thrombectomy Versus Pharmacomechanical Catheter-Directed Thrombolysis of Iliofemoral Deep Venous Thrombosis

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ObjectivesIliofemoral deep venous thrombosis (IFDVT) is strongly associated with post thrombotic syndrome (PTS). Interventional treatment options include catheter-directed thrombolysis (CDT) and pharmacomechanical thrombectomy (PMT). More recently, there has been a wide dissemination of large-bore devices for mechanical thrombectomy (MT). Both treatment types have been shown to be effective in clinical practice; however, the rates of PTS after MT are poorly characterized. MethodsWe conducted a retrospective review of patients with acute IFDVT from 2007 – 2022. Patients were divided into two treatment groups: PCDT and MT with large-bore devices. Our primary endpoint was PTS (Villalta score > 4). Secondary outcomes included vessel patency, mortality, and moderate/severe PTS (Villalta score > 9). Predictors of PTS were analyzed using multivariable logistic regression. ResultsThe median age of our cohort (n = 349) was 49 (IQR 35 - 63) years, 54.2% were female. There were 294 (84.2%) patients treated with PCDT. There were no significant baseline characteristic differences between patients treated with PCDT versus MT aside from increased preoperative anticoagulant use in the MT cohort. The overall rate of PTS was 19.1%. There were no differences in rates of PTS, mod-severe PTS, stent patency, mortality between groups, or hospital length of stay (LOS). However, patients treated with MT had higher rates of single operating room (OR) visit during their admission treatment relative to patients that underwent PCDT (33.3% vs. 9.0% , p < 0.01) and decreased intensive care unit LOS (2 (1-3) vs. 0.5 (0-2), p < 0.01). MT treatment was not a risk factor for the development of PTS (aOR 0.73; [95%CI 0.30, 1.74]; p = 0.47) or associated with increased Villalta score (β: -0.34; [95%CI -1.28, 0.60]; p = 0.47). Infrainguinal DVT extension (aOR 2.18; [95%CI 1.16, 4.09]; p = 0.02), prior DVT (aOR 2.67; [95%CI 1.38, 5.13]; p < 0.01), and a hypercoagulable state (aOR 2.32; [95%CI 1.19, 4.50]; p = 0.01) were associated with increased risk of PTS. ConclusionsTreatment with large-bore MT was not a significant predictor for the development of PTS. MT appears safe, durable, and associated with greater rates of single OR visit relative to PCDT, which suggests that rapid thrombus removal may be of value.