Clinical Implications of Multiple Endovascular Treatments for Patients with Lower Limb Deep Vein Thrombosis

ABSTRACT

PURPOSE: The aim of this study is to assess the clinical benefits of endovascular treatment for lower extremity deep vein thrombosis. Particularly, we wanted to define the factors that affect the recurrence of deep vein thrombosis (DVT) after repeated endovascular treatments. METHODS: Eighty six patients who were diagnosed with DVT from January 2003 to December 2008 were retrospectively examined. All the patients were diagnosed by lower extremity computed tomography scanning. Multimodality therapy was performed to achieve primary venous patency. The multimodality strategy included catheter-directed thrombolysis followed by percutaneous transluminal balloon angioplasty and stenting for any residual stenosis. RESULTS: Fifteen patients (17%) underwent repeated endovascular treatment. The onset of symptoms and a history of DVT were the factors that affected the recurrence of DVT. Repeated endovascular treatment showed considerably significant differences for recurrence between the single and multiple groups (28/71 [39.6%] vs. 9/15, respectively, [60%]) and for the mean venous patency duration (29.1 months [confidence interval (CI), 22.6~35.7] vs. 12.4 months, respectively, [CI, 6.7~20.2]) (P=0.001). CONCLUSION: Although multiple endovascular treatment demonstrated a favorable primary outcome, there were no definite benefits of multiple endovascular treatment on the long term follow-up. In the subgroup that has focal remnant thrombus, one more additional endovascular treatments would benefit for the recurred lower extremity deep vein thrombosis.