Iliocaval and Iliofemoral DVT Thrombectomy: A Multi-Institutional Patency Analysis

Sunday, March 5, 2023

3:27 PM – 3:36 PM

Location: Phoenix Convention Center, 221C

Abstract Speaker(s)

Gregg Khodorov, MD, MBA (he/him/his)

PGY-3 Integrated Diagnostic/Interventional Radiology Resident
Thomas Jefferson University Hospital Department of Radiology

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

YS

Yash B. Shah, BS

MS2
Sidney Kimmel Medical College at Thomas Jefferson University
BR

Bipasha Roy, BA

MS4
New York Medical College School of Medicine
Andrew Kesselman, MD

Clinical Assistant Professor
Stanford Medicine
Ronald Winokur, MD

Director
Weill Cornell Vein Treatment Center

Disclosure(s):

Gregg Khodorov, MD, MBA: No financial relationships to disclose

Andrew Kesselman, MD: No financial relationships to disclose

Ronald Winokur, MD: BD/Bard: Speaking and Teaching (Ongoing); Cordis: Consultant (Ongoing); Endovascular Engineering: Consultant (Ongoing); Inari medical: Consultant (Ongoing), Speaking and Teaching (Ongoing); Kalmaro Vascular: Consultant (Ongoing); Medtronic: Consultant (Ongoing), Speaking and Teaching (Ongoing); Mentice: Consultant (Ongoing); Penumbra: Speaking and Teaching (Ongoing)

Purpose: This study evaluated 1-year patency following iliocaval and iliofemoral venous recanalization and a standardized anticoagulation and antiplatelet regimen.

Materials and Methods: A retrospective analysis was performed for 270 patients who underwent endovenous stenting at two high-volume institutions for chronic or post-thrombotic obstruction from 5/10/2012-1/11/2022. Post-intervention anticoagulation and antiplatelet regimens were analyzed alongside stent patency. Demographic, baseline, procedural, and follow-up data were collected. Stent patency was evaluated via duplex Doppler ultrasound. Kaplan-Meier analyses of overall patency, as well as primary, primary-assisted, and secondary patency for patients with 1-year follow-up, were performed.

Results: Following exclusion of subjects missing follow-up, 228 patients were included. 207 (90%) patients received dual-therapy (1 antiplatelet and 1 anticoagulant), 16 (7%) triple-therapy (2 antiplatelets and 1 anticoagulant) and 5 (2%) single-therapy (anticoagulation alone). Kaplan-Meier analysis demonstrated 1-year overall patency probability of 87% (95% CI 80-91%) across all groups with no significant difference between therapeutic groups (p >0.05). 30 patients on dual-therapy (14%) had bleeding events, 26 of which were either immediately postprocedure or within 1 month. 3 patients (19%) on triple-therapy had bleeding events, all of which were immediately post-procedure. No bleeding events occurred in the single-therapy group. For the 176 patients with complete 1-year follow-up, primary patency was 57%, primary-assisted patency was 85%, and secondary patency was 92%.

Conclusion: This large cohort encompasses 10 years of data, with 90% uniformity in postprocedural dual-therapy after iliofemoral or iliocaval venous stenting, and demonstrates 87% overall patency probability across therapeutic cohorts. Moreover, those with 1-year follow-up demonstrated 57% primary, 85% primary assisted, and 92% secondary patency. These patency rates are similar to those found in the literature {1}. Given these findings, it can be deduced that dual-therapy is an acceptable post-procedural regimen to achieve 12-month patency in postthrombotic iliocaval or iliofemoral venous disease.