The Impact of Continued Catheter-Directed Thrombolysis after Stenting following Pharmacomechanical Thrombectomy for Iliofemoral DVT

Background: Iliac vein compression syndrome, also known as May–Thurner syndrome, causes acute iliofemoral deep vein thrombosis (DVT) by compressing the left common iliac vein between the right common iliac artery and the adjacent vertebrae. To restore iliofemoral flow and reduce postthrombotic syndrome, catheter-directed thrombolysis (CDT) and pharmacomechanical methods (PMT) have been examined. Symptomatic iliofemoral DVT is successfully treated with percutaneous CDT. Before using a mechanical rheolytic device (PMT), we treated acute or subacute lower extremities (DVT) using CDT for years with good results. PMT therapy with the mechanical rheolytic device has improved thrombolysis. Aim: The purpose of the study is to assess the effectiveness of continued CDT inpatient-received PMT and CDT as primary treatment with subsequent stenting in the same hospitalization for subjects presenting with acute iliofemoral DVT complicated by May–Thurner syndrome. Methods: A retrospective analysis of 20 iliofemorocaval DVT patients during 2021–2023. Patients admitted with acute DVT (onset <14 days) were included in the study. Children under 18, DVT onset >14 days, pregnant women, anticoagulant contraindicated, and pelvic tumor patients were excluded from this investigation. CDT was performed on 11 of 20 patients after primary stenting with continued CDT and 9 patients with primary PMT and stenting with continued CDT treatment. Patient demographics, periprocedural data, stent insertion, and lytic agent were collected. For 1 year after surgery, all individuals were screened for stent patency. Villalta score was recorded at regular intervals. Results: Twenty individuals were recruited. Nine women and 11 men participated in this study. The mean age of the study population was 57.7 ± 10.4232. The mean intervention onset was 6.05 ± 1.8489 days, ranging from 2 to 9. The average thrombectomy procedure lasted 33.26 ± 8.03 h. The mean hospitalization lasted 4.06 ± 0.87 days. Two subjects (10%) had moderate bleeding. Neither pulmonary embolism nor event recurrence were reported. All individuals had 100% stent patency. The mean Villalta score at 3, 6, and 12 months of screening was 0.15 ± 0.37, 0.25 ± 0.44, and 0.35 ± 0.67. Conclusion: Our study showed primary stenting benefits. One-year stent patency was 100% after primary stenting. Both therapies show a significant reduction in Villalta score postprocedure. After iliofemoral DVT, primary stenting improves clinical outcomes and stent patency.