Objective
To investigate the outcomes of treatment strategies for proximal and iliofemoral deep
vein thrombosis (DVT).
Methods
Randomised controlled trials (RCTs) investigating outcomes of catheter directed thrombolysis
(CDT), ultrasound assisted CDT (USCDT), percutaneous aspiration thrombectomy (PAT),
and best medical therapy (BMT) for proximal DVT from 2000 onwards were considered.
MEDLINE, EMBASE, and CINAHL were searched using the Healthcare Databases Advanced
Search interface developed by the National Institute for Health and Care Excellence.
The primary outcome was the rate of post-thrombotic syndrome (PTS), which was defined
using the Villalta scoring system (score of ≥5). Secondary outcomes included vessel
patency, recurrence, bleeding, and mortality. The network of evidence was summarised
using network plots, and random effects network meta-analyses were performed. The
certainty of evidence was assessed using the Certainty In Network Meta-Analysis (CINeMA)
approach.
Results
Seven RCTs meeting the inclusion criteria were identified. There were direct comparisons
between medical therapy, CDT, and USCDT across outcomes, except for patency. There
were no direct comparisons between medical therapy and PAT (except for patency), and
USCDT and PAT. There was no significant difference observed in PTS between the treatment
modalities for proximal and iliofemoral DVT (low certainty). There was a significant
difference in patency rates between medical therapy and USCDT (odds ratio [OR] 9.46,
95% confidence interval [CI] 3.05 – 29.35; low certainty) and CDT (OR 2.03, 95% CI
1.46 – 2.80; low certainty) in favour of USCDT and CDT, respectively, for proximal
DVT. USCDT significantly improved patency rates compared with CDT (OR 4.67, 95% CI
1.58 – 13.81; very low certainty) for proximal DVT. There was no significant difference
in DVT recurrence, bleeding, or mortality between treatment groups for proximal and
iliofemoral DVT (low to moderate certainty for most comparisons).
Conclusion
USCDT may improve patency rates compared with BMT and the other interventional treatment
modalities used for the management of proximal DVT. However, no treatment modality
showed superiority with regard to a reduction in PTS, and overall, the quality of
available evidence is poor.
Keywords
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Article Info
Publication History
Published online: January 24, 2022
Accepted:
October 31,
2021
Received:
May 9,
2021
Identification
Copyright
© 2021 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Management of Proximal DVT: Clinical Benefit of Endovenous Intervention Is Still in QuestionEuropean Journal of Vascular and Endovascular SurgeryVol. 63Issue 2
- PreviewA recent systematic review by Ashrafi et al. aimed to compare various techniques for treating proximal and iliofemoral deep vein thrombosis (DVT).1 Sixty per cent of lower extremity DVTs are proximal, defined as those involving the popliteal and/or more proximal veins, thereby contributing to feared complications such as pulmonary embolism and post-thrombotic syndrome (PTS). PTS refers to the constellation of pain, oedema, ulceration, and limited mobility caused by venous insufficiency following DVT.
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