Initial experience with the ambulatory management of acute iliofemoral deep vein thrombosis with May-Thurner syndrome with percutaneous mechanical thrombectomy, angioplasty and stenting

ObjectivePatients undergoing intervention for acute iliofemoral deep vein thrombosis (IFDVT) with May-Thurner syndrome (MTS) typically require inpatient (IP) hospitalization for initial treatment with anticoagulation and management with pharmacomechanical thrombectomy. Direct anticoagulants (DOACs) and percutaneous mechanical thrombectomy (PMT) devices offer the opportunity for outpatient (OP) management. Our approach with these patients is described in this report.MethodsPatients receiving intervention for acute IFDVT from January 2020 through October 2022 were retrospectively reviewed. Patients undergoing unilateral thrombectomy, venous angioplasty, and stenting for IFDVT with MTS comprised the study population and were divided into two groups: 1) patients admitted to the hospital and treated as IP, and 2) patients who underwent therapy as OPs. The two groups were compared regarding demographics, risk factors, procedural success, complications, and follow-up.ResultsNinety-two patients were treated for IFDVT with thrombectomy, angioplasty and stenting of which 58 comprised the IP group and 34 the OP group. All patients underwent PMT using the Inari ClotTriever®, intravascular ultrasound (IVUS), angioplasty, and stenting with 100% technical success. Three patients in the IP group required adjuvant thrombolysis. There was no difference in primary patency of the treated IFDVT segment at 12 months between the groups (IP 73.5%, OP 86.7%, p=0.21, Logrank)ConclusionsPatients with acute IFDVT and MTS deemed appropriate for thrombectomy and iliac revascularization can be managed with initiation of ambulatory DOAC therapy and subsequent return for ambulatory PMT, angioplasty, and stenting. This approach avoids the expense of IP care and allows for effective use of resources at a time when staffing and supply chain shortages have led to inefficiencies in the provision of IP care for non-emergent conditions.