Predictive factors for complete recovery of post-thrombotic syndrome 6 months after venous recanalization

Abstract

Objective: Endovascular recanalization is considered for severely symptomatic patients with post-thrombotic syndrome (PTS) to alleviate symptoms. However, data on complete recovery and its predictors remain limited. This study aimed to assess persistent PTS 6 months after venous recanalization and identify predictive factors.

Design: Single-center retrospective outcome-oriented cohort study.

Methods: We reviewed electronic medical records of patients referred for endovascular venous recanalization between January 1, 2015, and September 30, 2019. Inclusion criteria were PTS defined by a Villalta score of ≥5 or a leg ulcer ≥6 months after a deep vein thrombosis episode. Complete PTS recovery was defined as a Villalta score of <5.

Results: Sixty-seven patients (median age, 40 years; interquartile range, 32-51 years; 78% women; 18% obese) were included. The initial Villalta score was 10 (interquartile range, 7-14). At 6 months, primary and secondary patency rates were 75% and 81%, respectively. Complete recovery was observed in 67% of patients. Multivariate analysis identified the initial Villalta score (odds ratio, 1.36; 95% confidence interval, 1.12-1.65; P = .002) and femoral vein obstruction (odds ratio, 3.79; 95% confidence interval, 1.06-13.61; P = .041) as predictors of persistent PTS, whereas long-term anticoagulation was not significant.

Conclusions: Endovascular recanalization achieved PTS resolution in two-thirds of patients at 6 months, particularly in those with a low initial Villalta score and no femoral vein obstruction. A risk score incorporating these factors may aid clinicians in patient counseling regarding the expected benefits of the procedure.

Keywords: Chronic venous thrombotic obstruction; Deep venous thrombosis; Post-thrombotic syndrome; Prediction; Stenting.