Endovascular Management of Acute Lower Limb Deep Vein Thrombosis: A Systematic Review and Meta-analysis.

BACKGROUND: Deep vein thrombosis (DVT) is associated with significant complications, including the development of post-thrombotic syndrome (PTS). Traditional management is with oral anticoagulation, but the endovascular techniques of catheter-directed thrombolysis (CDT), pharmacomechanical thrombolysis, and venous stenting are now increasingly used. This study aims to review the evidence for these endovascular techniques in the management of acute lower limb DVT, and their role in the reduction of complications such as PTS.

METHODS: A systematic review and meta-analysis was carried out, with studies that compared CDT, pharmacomechanical thrombolysis, and/or venous stenting with oral anticoagulation included. Primary outcome measure was the incidence of PTS; secondary outcome measures were the incidence of recurrent venous thromboembolism (VTE) and bleeding complications. Treatment effects were calculated as risk ratios (RR) with their 95% confidence interval (CI).

RESULTS: Five studies met the final inclusion criteria. CDT reduced the incidence of PTS (RR 0.56, 95% CI 0.43-0.73), whereas pharmacomechanical thrombolysis had only a minor effect on the incidence of PTS that did not achieve statistical significance (RR 0.87, 95% CI 0.75-1.01). Recurrent VTE following CDT was reduced compared to oral anticoagulation (RR 0.62, 95% CI 0.34-1.13), while bleeding complications were more likely following CDT (RR 5.11, 95% CI 2.16-12.08).

CONCLUSIONS: CDT decreases the incidence of PTS when treating iliofemoral DVT, but pharmacomechanical thrombolysis does not. CDT also reduces the incidence of recurrent VTE, but leads to more bleeding complications when compared to oral anticoagulation. Further randomized controlled trials are needed to determine the role of endovascular management of DVT occurring below the iliofemoral level, and the role of venous stenting.