Incidence of caval extension of iliofemoral DVT in patients undergoing thrombectomy

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Akash Desai, MD

Integrated Resident
Einstein Health Care Network

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

AA

Alexander Anavim, MD

Integrated IR/DR Resident Physician
Einstein Medical Center, Jefferson Health
Isael Perez, Jr., MD

Independent IR Resident Physician
Einstein Medical Center - Thomas Jefferson
Jung H. Yun, MD

Integrated IR/DR Resident Physician
Einstein Medical Center, Jefferson Health
SD

Sagar Desai, DO (he/him/his)

IR/DR Resident
Jefferson Einstein Hospital
SL

Shiyi Li, MD

Integrated IR/DR Resident Physician
Einstein Medical Center, Jefferson Health
VK

Vinit Khanna, MD

Interventional Radiologist
Einstein Medical Center

Disclosure(s):

Akash Desai, MD: No financial relationships to disclose

Alexander Anavim, MD: No financial relationships to disclose

Jung H. Yun, MD: No financial relationships to disclose

Shiyi Li, MD: No financial relationships to disclose

Purpose: Endovascular treatment of iliofemoral DVT can reduce the incidence of post thrombotic syndrome. In patients who are candidates for endovascular treatment caval extension of DVT can affect procedural planning and equipment decisions. Workup for DVT begins with lower extremity duplex venous ultrasound, which is not sensitive for determining IVC extension. CT venogram provides a sensitive and specific alternative but comes with additional cost. The purpose of this study is to delineate clinical or ultrasound factors to predict caval extension of iliofemoral DVT and determine the subset of patients who would benefit from CT venography prior to intervention.

Materials and Methods: Retrospective review of all patients for whom catheter directed treatment of lower extremity iliofemoral DVT was performed at our institution from 10/2019- 10/2022. Patients who had unilateral and bilateral iliofemoral DVT were included. Initial venous duplex ultrasound studies were reviewed to evaluate the extent of unilateral/ bilateral DVT. Subsequent invasive venography images and CT venogram images when available were used to determine the presence of IVC thrombus. Venogram images were also used to determine if there were anatomic explanations for the DVTs and caval extension.

Results: A total of 68 patients had dvt thrombectomy procedures performed at our institution during the study period. Of these 68, 59 patients had unilateral DVT and 9 had bilateral DVT. Of the patients with bilateral DVT, 9 (100%) had caval extension of thrombus while 9 (15.2%) patients with unilateral DVT had caval extension. Of the 9 patients with unilateral DVT with caval extension, there were 5 had IVC filters or p</span>elvic venous stents in place while 4 patients did not. Only 4/59 (6.7%) patients with unilateral DVT had caval extension of thrombus. 11/19 (57.8%) patient with caval extension of thrombus had a prior IVC filter or pelvic venous stents.

Conclusion: Patients undergoing catheter directed therapy for unilateral iliofemoral DVT diagnosed on venous duplex have a low incidence of caval extension of thrombus except when IVC filter or pelvic venous stents are present. Patients with bilateral DVT on the other hand have a very high incidence of caval extension. Patients with bilateral DVT and all patients with IVC filter would benefit from CT venography prior to intervention.