Thrombus volume reduction surgery significantly increased femoral vein valve preservation at 12 months to 75.8% compared to 43.9% with simple anticoagulation in patients with acute iliofemoral deep vein thrombosis.
Cohort (n=504)
Single-blind (outcome assessors)
No
Does thrombus volume reduction surgery improve femoral vein valve preservation in patients with acute iliofemoral deep vein thrombosis?
Thrombus volume reduction surgery is associated with improved femoral vein valve preservation and a lower incidence of post-thrombotic syndrome compared to simple anticoagulation in patients with acute iliofemoral deep vein thrombosis.
Effect estimate: OR 3.85 (95% CI 2.45-6.05)
Absolute Event Rate: 75.8% vs 43.9%
p-value: p=<0.001
Background Acute iliofemoral deep vein thrombosis (IFDVT) often leads to femoral vein valve incompetence and post-thrombotic syndrome (PTS). This study evaluated whether thrombus volume reduction surgery (TVRS) is associated with better valve function preservation compared with simple anticoagulation (SA) in patients with acute IFDVT. Methods A combined retrospective and prospective cohort study involving 504 patients with acute IFDVT compared TVRS (n = 238) and SA (n = 266). The primary outcome was the femoral vein valve preservation rate at 12 months. Secondary outcomes included PTS incidence and quality of life. Subgroup analysis compared two pharmacomechanical thrombectomy devices: AngioJet and Acostream. Propensity score matching (1:1 nearest neighbor, caliper 0.05), inverse probability of treatment weighting, and E-value sensitivity analysis were employed to address confounding. An exploratory mediation analysis (hypothesis-generating) examined whether valve preservation potentially mediates the association between TVRS and PTS reduction. Results The TVRS group showed a significantly higher valve preservation rate (75.8% vs. 43.9%, P < 0.001) and a lower incidence of moderate-to-severe PTS (13.6% vs. 34.8%, P = 0.002) compared with the SA group. TVRS patients also achieved better quality of life scores with comparable safety profiles. In a pre-specified, exploratory subgroup analysis of patients who underwent PMT with complete ultrasound follow-up data (n = 50 per device), AngioJet appeared to be associated with a higher valve preservation rate compared with Acostream (82% vs. 70%, P = 0.04), although this comparison was underpowered, non-randomized, and should be considered strictly hypothesis-generating. Conclusions TVRS was associated with improved femoral vein valve preservation, lower PTS incidence, and enhanced quality of life compared with SA. The AngioJet system may be associated with better valve protection than the Acostream system, but this finding is exploratory and requires validation in randomized trials. These observations support the hypothesis that early thrombectomy intervention may be beneficial for long-term venous function, but cannot establish causality.
Wang et al. (Wed,) conducted a cohort in Acute iliofemoral deep vein thrombosis (IFDVT) (n=504). Thrombus volume reduction surgery (TVRS) vs. Simple anticoagulation (SA) (LMWH 100 IU/kg q12h transitioned to rivaroxaban) was evaluated on Femoral vein valve function preservation at 12 months (OR 3.85, 95% CI 2.45-6.05, p=<0.001). Thrombus volume reduction surgery significantly increased femoral vein valve preservation at 12 months to 75.8% compared to 43.9% with simple anticoagulation in patients with acute iliofemoral deep vein thrombosis.