Comparative analysis of catheter-directed thrombolysis and mechanical thrombectomy in iliofemoral deep vein thrombosis: clinical evidence and perspectives – a narrative review

BACKGROUND: Illofemoral deep vein thrombosis (DVT) involves thrombus formation in the iliac and/or femoral veins and can lead to significant morbidity, including pulmonary embolism and post-thrombotic syndrome (PTS). Traditional anticoagulation remains the standard treatment, but newer endovascular techniques such as catheter-directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT), and pharmacomechanical thrombolysis (PMT) are gaining prominence for their potential benefits in clot removal and limb preservation. OBJECTIVE: This review aims to compare the efficacy and safety of these minimally invasive endovascular modalities in the management of illofemoral DVT. METHODS: A comprehensive literature review was conducted, analysing articles published between June 2019 and June 2024 from PubMed, Lilacs, and Cochrane Library databases. Inclusion criteria comprised clinical studies, systematic reviews, and meta-analyses in English, Portuguese, or Spanish. Data from 50 selected articles were synthesised qualitatively, focusing on treatment success, vessel patency, symptom relief, incidence of PTS, and complications. RESULTS: Both CDT and PMT demonstrated high success rates, with complete thrombus removal in 82% and 72% of cases, respectively. Combined approaches such as pharmacomechanical thrombolysis showed promising short- and medium-term patency and symptom improvement. Studies highlighted reduced PTS severity using advanced techniques like ultrasound-assisted thrombolysis and Angiolet thrombectomy, though long-term data remain limited. Safety profiles revealed low complication rates, primarily minor bleeding, with serious adverse events being infrequent. CONCLUSION: Endovascular interventions, including CDT and PMT, offer effective, minimally invasive alternatives to anticoagulation in illofemoral DVT, with advantages in early thrombus removal and limb salvage. Careful patient selection and procedure planning are critical to optimise outcomes, and long-term studies are warranted to further assess durability and complication rates.