Impact of Endovascular Treatment on the Development of Post-Thrombotic Syndrome in Iliac and Iliofemoral Deep Vein Thrombosis.

Background

Post-thrombotic syndrome (PTS) is a frequent complication of deep vein thrombosis (DVT), with significant clinical and quality-of-life implications. Endovascular techniques have emerged as potential strategies to reduce PTS severity in selected patients, though evidence remains inconclusive.

Methods

We conducted a multicenter, retrospective study including 176 patients with iliac or iliofemoral DVT from four hospitals in Murcia, Spain. Patients were treated either with anticoagulation alone (n = 121) or with endovascular techniques followed by anticoagulation (n = 55). The primary outcome was the presence of PTS at 12 months, defined by the presence of ≥5 signs/symptoms from the Villalta scale. Multivariate analysis was performed to identify independent predictors of PTS.

Results

No significant differences were observed in the overall prevalence of PTS between the endovascular and anticoagulation-only groups at 12 months (25.4% vs. 23.2%, p = 0.63). However, edema and skin hyperpigmentation were significantly more frequent in the anticoagulation-only group. Patients treated with endovascular techniques had lower rates of residual thrombosis at follow-up (34.6% vs. 53.9%, p = 0.03). Multivariate analysis identified residual thrombosis (OR 6.3, 95% CI 2.74-14.5), persistently elevated D-dimer (OR 3.26, 95% CI 1.1-9.7), and age (OR 1.02, 95% CI 1.003-1.042) as independent predictors of PTS. Mortality was significantly higher in the anticoagulation-only group, largely driven by a higher cancer prevalence.

Conclusions

Endovascular techniques did not significantly reduce the overall incidence of PTS but were associated with lower rates of specific signs such as edema and hyperpigmentation. Residual thrombosis remains a key predictor of PTS and may represent a modifiable therapeutic target.