Factors Associated With Symptom Resolution Following Treatment Of Iliofemoral Deep Vein Thrombosis
Jones P. Thomas, MD, Ashlei C. Beiswenger, MS, BSE, Michael Brown, DO, Norman Kumins, MD, Vikram S. Kashyap, MD, Vivek R. Sreeram, MD, Karem C. Harth, MD.
University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Objective:
Management of complex deep venous pathology is rapidly expanding. As knowledge, technique and technologies emerge, so will approaches to successfully treating these conditions. The purpose of this study was to determine factors associated with symptom resolution following intervention for acute or subacute iliofemoral DVT.
Methods:
This study was a single-institution, retrospective review of all patients who received treatment for iliocaval system DVT over a two-year period (2017-2018). Information on patients’ demographics, treatment characteristics, medical management and post-procedural surveillance were collected. Data were stratified by patient symptom resolution (complete, partial, none) at time of discharge and the first post-operative follow up visit (within 1-3 months of procedure). Single-variate analyses comparing continuous variables used t-test, and those comparing categorical variables used the 𝜒;2 test.
Results:
Of the 48 interventions performed between 2017-2018 with recorded symptom resolution data, 12 (25%) subjects had no symptom relief, 20 (42%) had partial symptom resolution, and 16 (33%) had complete resolution of symptoms at discharge or first follow-up. Higher percentages of complete and partial symptom resolution vs. no symptom resolution were found with the use of intravascular ultrasound (IVUS) during the intervention (88%, 65%, 35%, respectively; p<0.01), placing stents (94%, 60%, 50%, respectively; p=0.03), and extending stents into the external iliac veins (75%, 50%, 25%, p=0.03). The use of direct oral anticoagulants (DOACs) after intervention was significantly associated with higher rates of no symptom resolution (83%, 30% partial; 38% complete; p=0.01).
Conclusions:
Outcomes associated with intervention for acute iliofemoral DVT are dependent on multiple factors. Our study reinforces the importance of IVUS as well as stenting of culprit lesions following clearance of acute thrombosis. We found that extending stents into the external iliac veins to be associated with improvement in outcomes. This likely reflects the importance of identifying and treating inflow lesions after treating outflow lesions. Additionally, choice of anticoagulant after intervention also appears to have an association with symptoms resolution. Further studies are needed to guide optimal technique and medical therapy. 
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