Endovascular therapy versus anticoagulation alone for subacute iliofemoral deep vein thrombosis

Purpose: This study evaluated whether endovascular therapy (ET) improved early symptom relief and decreased the incidence of moderate-to-severe post-thrombotic syndrome (PTS) compared to anticoagulation alone in patients with subacute (15-28 days) iliofemoral deep vein thrombosis (DVT).

Materials and methods: Consecutive patients with subacute iliofemoral DVT from January 2020 to June 2022 were identified. A total of 86 patients were categorized to treatment with ET alongside anticoagulation (endovascular group, n = 49) or anticoagulation alone (anticoagulation group, n = 37). Effectiveness outcomes including thrombus clearance rate, symptoms relief in 3 days (pain and swelling score), moderate-to-severe PTS rate, Villalta score, and Venous Clinical Severity Score (VCSS) at 12 months, as well as safety outcomes including major bleeding, minor bleeding, and death within 12 months were compared between the two groups.

Results: The endovascular group demonstrated greater symptoms relief in 3 days (1.1±1.0 vs. 3.6±1.1, P<0.001). The mean follow-up duration was 15.9 months for the endovascular group and 14.7 months for the anticoagulation group. Seventy-nine patients (91.8%) completed the 12-month follow-up. Villalta score (3.9±2.6 vs. 5.7±4.3; P =0.027), moderate-to-severe PTS (6.5% vs. 27.3%; P =0.011), and VCSS score (2.3±1.6 vs. 3.6±2.6; P =0.004) at 12 months were significantly lower in the endovascular group. No significant differences were observed regarding minor bleeding events, recurrence of symptomatic DVT, and deaths between the two groups.

Conclusions: In patients with subacute iliofemoral DVT, the addition of ET to anticoagulation provided greater early symptoms relief and reduced the occurrence of moderate-to-severe PTS, with similar safety outcomes.