Peripheral thrombus extension is associated with increased risk of recurrent deep venous thrombosis in patients undergoing percutaneous thrombectomy for iliofemoral deep venous thrombosis.

OBJECTIVE: Patients presenting with iliofemoral deep venous thrombosis (DVT) often undergo percutaneous thrombectomy intending to prevent post-thrombotic syndrome. However, the relationship between the extent of DVT and outcomes after thrombectomy has not been explored. The objective of this study was to compare rates of post-thrombectomy DVT recurrence between patients with isolated iliofemoral DVT and patients with iliofemoral DVT and extension more peripherally.

METHODS: We conducted a single-center, retrospective analysis of all patients who underwent thrombectomy for iliofemoral DVT from 2014 to 2023. Patients were stratified into two cohorts: (1) iliofemoral DVT without popliteal/tibial extension or (2) iliofemoral DVT with popliteal/tibial extension. The primary outcome was acute DVT recurrence and multivariable analysis was performed to identify risk factors for recurrence. The χ2 test and t test were calculated for categorical and continuous data, respectively. Kaplan-Meier analysis was used to compare rates of acute DVT and chronic venous changes postoperatively. A P value of <.05 was considered statistically significant.

RESULTS: We identified 222 patients during the study period (76 isolated iliofemoral DVT vs 146 iliofemoral DVT with peripheral extension) with a median follow-up of 19 months. Patients who presented with iliofemoral DVT with peripheral extension were more likely to be older (57 years vs 50 years; P = .004), have hypertension (64% vs 41%; P = .001) or hyperlipidemia (58% vs 40%; P = .01), and to have had surgery within the prior 6 months (29% vs 17%; P = .04). Among the female patients, those on hormone therapy were more likely to have isolated iliofemoral DVT (17% vs 3%; P < .001). Patients with iliofemoral DVT with peripheral extension had a greater chance of developing recurrent acute DVT (48% vs 20%; P < .001) and chronic venous changes (51% vs 30%; P = .004) during follow-up. Multivariable analysis showed a significant correlation between iliofemoral DVT with peripheral extension (odds ratio, 3.8; 95% confidence interval, 1.7-8.7; P = .001) and acute DVT recurrence. There were no differences in the rates of reintervention or death.

CONCLUSIONS: A more extensive peripheral thrombus burden was associated with higher rates of follow-up DVT recurrence in patients undergoing thrombectomy for iliofemoral DVT. These findings suggest that such patients may require closer follow-up and more aggressive anticoagulation therapy postoperatively. Moreover, our results provide a framework for further studies to specifically study the role peripheral thrombus may play in venous hemodynamics and the development of recurrent DVT and, ultimately, post-thrombotic syndrome.