Thromboembolic Risk of Endovascular Intervention for Lower Extremity Deep Venous Thrombosis

Ann Vasc Surg. 2018 May;49:247-254. doi: 10.1016/j.avsg.2017.10.004. Epub 2017 Nov 29.

Abstract

Background: This study evaluated the risk of thromboembolism during endovascular interventions in patients with symptomatic lower extremity deep vein thrombosis (DVT) METHODS: Clinical records of all patients who underwent endovascular interventions for symptomatic lower extremity DVT from 2001 to 2017 were retrospectively analyzed using a prospectively maintained database. Only patients who received an inferior vena cava (IVC) filter were included in the analysis. Trapped intrafilter thrombus was assessed for procedure-related thromboembolism. Clinical outcomes of thrombus management and thromboembolism risk were analyzed.

Results: A total 172 patients (mean age 57.4 years, 98 females) who underwent 174 endovascular DVT interventions were included in the analysis. Treatment strategies included thrombolytic therapy (64%), mechanical thrombectomy (n = 86%), pharmacomechanical thrombolysis (51%), balloon angioplasty (98%), and stent placement (28%). Thrombectomy device used included AngioJet (56%), Trellis (19%), and Aspire (11%). Trapped IVC filter thrombus was identified in 58 patients (38%) based on the IVC venogram. No patient developed clinically evident pulmonary embolism (PE). IVC filter retrieval was performed in 98 patients (56%, mean 11.8 months after implantation). Multivariate analysis showed that iliac vein occlusion (P = 0.04) was predictive for procedure-related thromboembolism.

Conclusions: Iliac vein thrombotic occlusion is associated with an increased thromboembolic risk in DVT intervention. Retrievable IVC filter should be considered when performing percutaneous thrombectomy in patients with iliac venous occlusion to prevent PE.

MeSH terms

  • Adult
  • Aged
  • Chi-Square Distribution
  • Databases, Factual
  • Disease-Free Survival
  • Endovascular Procedures / adverse effects*
  • Endovascular Procedures / instrumentation
  • Endovascular Procedures / methods
  • Female
  • Humans
  • Iliac Vein* / diagnostic imaging
  • Kaplan-Meier Estimate
  • Logistic Models
  • Lower Extremity / blood supply*
  • Male
  • Medical Records
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Phlebography
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / etiology*
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vena Cava Filters
  • Venous Thrombosis / diagnostic imaging
  • Venous Thrombosis / therapy*
  • Young Adult