Impact of concomitant popliteal vein thrombosis in patients with acute iliofemoral deep vein thrombosis treated with endovascular early thrombus removal.

Abstract

Background: Catheter-based thrombus removal (CBTR) reduces the risk of moderate to severe post-thrombotic syndrome (PTS) in patients with acute iliofemoral deep vein thrombosis (IF-DVT). However, the impact of concomitant popliteal DVT on clinical and duplex sonographic outcomes is unknown. Patients and methods: In this post-hoc analysis including the entire cohort of the randomized controlled BERNUTIFUL trial (48 patients), we compared clinical (incidence/severity of PTS assessed by Villalta score and revised venous clinical severity scores, rVCSS), disease-specific quality-of-life (QOL, CIVIQ-20 survey) and duplex sonographic outcomes (patency, reflux, post-thrombotic lesions) at 12 months follow-up between patients with IF-DVT with and without concomitant popliteal DVT treated by CBTR. Results: Overall, 48 IF-DVT patients were included (48% men, median age of 50 years), of whom 17 (35%) presented with popliteal DVT. At baseline, patients with popliteal DVT were older, had a higher body mass index and more important leg swelling. At 12 months, freedom from PTS (93% vs 87%, P=0.17), median total Villalta score (1 vs 1.5; P=0.46), rVCSS (2 vs 1.5, P=0.5) and disease-specific QOL (24 points vs 24 points, P=0.72) were similar between patient with and without popliteal DVT, respectively. Duplex sonographic outcomes were similar, except for more frequent popliteal post-thrombotic lesions and reflux (P=0.02) in patients with popliteal DVT. Conclusions: Relevant clinical outcomes 1 year after successful CBTR were favorable, regardless of the presence or absence of concomitant popliteal DVT. However, post-thrombotic popliteal vein lesions and reflux are more frequent in IF-DVT patients with popliteal involvement. Their impact on long-term outcomes remains to be investigated.

• Authors: Vincent Frey, Tim Sebastian, Stefano Barco, David Spirk, Daniel Hayoz, Daniel Périard, Nils Kucher, Daniel Betticher, Rolf P Engelberger
• Journal: VASA. Zeitschrift fur Gefasskrankheiten (Vasa) Vol. 51 Issue 5 Pg. 282-290 (Sep 2022) ISSN: 0301-1526 [Print] Switzerland
• PMID: 35774017 (Publication Type: Journal Article, Randomized Controlled Trial)

Topics

• Female
• Femoral Vein (diagnostic imaging)
• Humans
• Iliac Vein (diagnostic imaging)
• Male
• Middle Aged
• Popliteal Vein (diagnostic imaging, pathology)
• Postthrombotic Syndrome (etiology, therapy)
• Quality of Life
• Thrombolytic Therapy (adverse effects)
• Treatment Outcome
• Venous Thrombosis (complications, diagnostic imaging, therapy)