Breaking the Blockage by Advancing Treatment Strategies for Upper Extremity Deep Vein Thrombosis

BACKGROUND: Catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT) are established endovascular strategies for the treatment of deep vein thrombosis (DVT). However, comparative outcomes data specific to upper extremity deep vein thrombosis (UEDVT) remain limited. Given that PMT is associated with improved outcomes in lower extremity DVT, we hypothesize that PMT is associated with improved mortality and morbidity compared to CDT in treating UEDVT. This study evaluates outcomes associated with CDT versus PMT for UEDVT and Paget-Schroetter Syndrome (PSS). METHODS: A retrospective cohort study was conducted using the TriNetX US Collaborative Network. Patients diagnosed with UEDVT who underwent CDT (n=1,399) or PMT (n=1,406) between 2005 and 2025 were identified. Patients who received both modalities were excluded. Propensity score matching was performed, yielding 1,198 patients in each cohort (n=2,396) balanced across demographics, comorbidities (including malignancy, type 2 diabetes mellitus, hypertension, coagulation disorders, and end-stage renal disease), and medication use. A subgroup analysis was performed for patients with PSS who underwent CDT or PMT, with similar propensity score matching (n=280). Thirty-day and one-year outcomes were compared using odds ratios (ORs). RESULTS: After matching, pulmonary embolism (PE) rates did not differ significantly between groups at 30 days or one year. Compared with PMT, CDT was associated with significantly higher odds ratio of 30-day mortality (OR, 1.82), myocardial infarction (OR, 2.43), ischemic stroke (OR, 9.11), transfusion (OR, 1.95), 30-day readmission (OR, 2.34), and intracranial hemorrhage (OR, 6.59). These differences persisted at one year, with CDT demonstrating significantly higher OR of mortality (OR, 1.56), myocardial infarction (OR, 2.01), ischemic stroke (OR, 6.69), and intracranial hemorrhage (OR, 3.93). Repeat intervention occurred more frequently in the PMT cohort at one year (12.2% versus 7.68%; OR 1.67). Among patients with PSS, one-year mortality was low in both groups. There were no significant differences in PE or subsequent first rib resection between CDT and PMT treated patients. However, repeat intervention occurred more frequently in the PMT cohort (21.4% vs 10.7%; OR 2.27). CONCLUSION: In this national propensity-matched analysis, CDT for UEDVT was associated with higher 30-day and one-year morbidity and mortality compared with PMT, whereas PMT was associated with a greater need for repeat intervention. In patients with PSS, CDT and PMT demonstrated similar clinical outcomes, although PMT was associated with higher reintervention rates. These findings suggest differential risk profiles between the two treatment strategies and may inform procedural selection in the management of UEDVT.