Single Session Thrombolysis-free Percutaneous Aspiration Mechanical Thrombectomy for Acute Iliofemoral Deep Vein Thrombosis: Technical Success, Patency, and Early Functional Recovery – A Single-center Experience

Background: Acute iliofemoral deep vein thrombosis (DVT) is associated with severe limb symptoms and an increased risk of postthrombotic syndrome (PTS). Although anticoagulation prevents thrombus propagation, it does not rapidly restore venous outflow. Thrombolysis-free percutaneous aspiration mechanical thrombectomy (PAMT) enables rapid thrombus removal and symptom relief while avoiding bleeding complications associated with fibrinolytic therapy. Methods: This single-center retrospective study included 26 patients with symptomatic, imaging-confirmed acute iliofemoral DVT (<14 days from symptom onset) treated between December 2023 and April 2025. Baseline evaluation included computed tomography (CT) venography and CT pulmonary angiography. PAMT was performed through ultrasound-guided ipsilateral popliteal venous access using the Penumbra Indigo Lightning 12 system. Patients received low-molecular-weight heparin during hospitalization and were transitioned to direct oral anticoagulants at discharge. The primary endpoint was complete or near-complete thrombus removal (>90% thrombus clearance on venography with restoration of inline venous flow, SIR Grade II and III). Secondary endpoints included early symptom improvement, duplex ultrasound-confirmed freedom from venous occlusion at 3 and 6 months, symptom severity assessment using the Villalta score at 1, 3, 6, and 15 months, complications, and time to return to usual activities. Results: The mean age was 43.3 years and 57.7% were female. Left-sided DVT occurred in 88.5% of patients and 73.1% were unprovoked. Asymptomatic pulmonary embolism was detected in 23.1%. The primary endpoint was achieved in all patients (100%), with a mean procedure time of 50 min and estimated blood loss of approximately 130–140 mL. Adjunct balloon venoplasty was required in 46.2% of patients. Significant symptom improvement was observed within 24 h in all patients. Duplex ultrasound confirmed the absence of reocclusion in all patients at 3 and 6 months, and a median Villalta score of 4 was maintained through 15 months of follow-up. One minor access-site hematoma occurred with no major complications. Median hospital stay was 36 h, and return to usual activities occurred within 4–7 days. Conclusions: Thrombolysis-free PAMT demonstrated excellent technical success, rapid symptom relief, and sustained short-term venous patency without rethrombosis, with a low complication rate. Larger studies with longer follow-up are required to evaluate long-term outcomes and the role of PAMT in the prevention of PTS.