Iliocaval and Iliofemoral DVT Thrombectomy: A Multi-Institutional Patency Analysis

Purpose: This study evaluated 1-year patency following iliocaval and iliofemoral venous recanalization and a standardized anticoagulation and antiplatelet regimen.

Materials and Methods: A retrospective analysis was performed for 270 patients who underwent endovenous stenting at two high-volume institutions for chronic or post-thrombotic obstruction from 5/10/2012-1/11/2022. Post-intervention anticoagulation and antiplatelet regimens were analyzed alongside stent patency. Demographic, baseline, procedural, and follow-up data were collected. Stent patency was evaluated via duplex Doppler ultrasound. Kaplan-Meier analyses of overall patency, as well as primary, primary-assisted, and secondary patency for patients with 1-year follow-up, were performed.

Results: Following exclusion of subjects missing follow-up, 228 patients were included. 207 (90%) patients received dual-therapy (1 antiplatelet and 1 anticoagulant), 16 (7%) triple-therapy (2 antiplatelets and 1 anticoagulant) and 5 (2%) single-therapy (anticoagulation alone). Kaplan-Meier analysis demonstrated 1-year overall patency probability of 87% (95% CI 80-91%) across all groups with no significant difference between therapeutic groups (p >0.05). 30 patients on dual-therapy (14%) had bleeding events, 26 of which were either immediately postprocedure or within 1 month. 3 patients (19%) on triple-therapy had bleeding events, all of which were immediately post-procedure. No bleeding events occurred in the single-therapy group. For the 176 patients with complete 1-year follow-up, primary patency was 57%, primary-assisted patency was 85%, and secondary patency was 92%.

Conclusion: This large cohort encompasses 10 years of data, with 90% uniformity in postprocedural dual-therapy after iliofemoral or iliocaval venous stenting, and demonstrates 87% overall patency probability across therapeutic cohorts. Moreover, those with 1-year follow-up demonstrated 57% primary, 85% primary assisted, and 92% secondary patency. These patency rates are similar to those found in the literature {1}. Given these findings, it can be deduced that dual-therapy is an acceptable post-procedural regimen to achieve 12-month patency in postthrombotic iliocaval or iliofemoral venous disease.