Pharmacomechanical catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis in a large study population

Background: We have analyzed our single-center immediate and follow-up results in the management of acute iliofemoral deep vein thrombosis (IFDVT) using pharmacomechanical catheter-directed thrombolysis (PMCDT) to determine the safety, accuracy, and effects on quality of life and whether this treatment strategy prevents post-thrombotic syndrome (PTS). Methods: The cases of 230 patients who had undergone PMCDT to treat IFDVT from January 2017 to December 2018 were retrospectively reviewed. The preoperative, operative, and postoperative variables, Marder scores, outcomes, and follow-up assessments with the Villalta score and venous clinical severity score were investigated. Results: Anatomic success was achieved for 95.2% of the 230 patients. The mean Marder score had decreased from 12.65 +/- 2.1 to 2.4 +/- 1.3 postoperatively (P < .01). Early recurrent thrombosis had developed in 13 patients (5.65%). The primary patency at the 1-, 6-, and 12-month follow-up visits was 94.0%, 87.2%, and 81.7%, respectively. From 1 to 6 months, the Villalta score had decreased from 8.32 +/- 4.14 to 3.43 +/- 0.61 and the venous clinical severity score had decreased from 4.0 +/- 1.8 to 1.82 +/- 0.36 (P < .05). No statistically significant difference was found in the PTS severity scores at 12 months of follow-up compared with at 6 months. The mean change in the venous disease-specific quality of life from baseline to 12 months was 29.41 +/- 1.99 (P = .029). The total recurrence rate was 19.63% at 1 year. Conclusions: For a select group of patients with acute IFDVT, the use of PMCDT and postoperative anticoagulation therapy offered significant reductions in clot burden, leg pain, and swelling, achieving a significant reduction in PTS severity scores at 6 months.