39 - Innovations in DVT Treatment: An Evidence-Based Review of Proximal and Distal Approaches

Mina Makary, MD, DABR, FSVM, FAHA, FASA – Associate Professor - Clinical, Radiology, The Ohio State University Wexner Medical Center

Purpose: Deep vein thrombosis (DVT) of the lower limbs is a prevalent and serious condition, affecting 9.3 per 10,000 individuals annually. DVT is categorized as proximal (inferior vena cava to popliteal vein) or distal (below the knee), with treatment goals focused on symptom resolution, quality of life improvement, and minimizing adverse events. This work presents an evidence-based review of the current data on effectiveness and long-term outcomes by treatment modality for proximal DVT (PDVT) and distal DVT (DDVT).

Material and Methods: A comprehensive review of guidelines and clinical data was conducted, focusing on management approaches to PDVT and DDVT. Data were collected from PubMed-indexed literature, recent and ongoing clinical trials, and guidelines from the Society of Interventional Radiology (SIR) and the American Society of Hematology (ASH).

Results: Current guidelines from SIR and ASH encourage prompt systemic or catheter-directed anticoagulation for PDVT based on severity and bleeding risk, while urgency for DDVT treatment varies. Mechanical thrombectomy (MT) is generally not recommended due to uncertain efficacy compared to pharmacologic methods but may be viable for limb-threatening DVT. Less consensus exists for DDVT management, but recent and ongoing clinical trials have had intriguing results. Comparison of data from the ATTRACT trial and CLOUT registry revealed that anticoagulation alone significantly increases risk of post-thrombotic syndrome (PTS), a chronic complication of DVT, compared to MT. To further optimize PDVT and DDVT management, large clinical trials are needed. One example is the RIETE Registry, an ongoing international clinical registry of acute VTE started in 2001. With advances in MT technology and endovascular anticoagulation, improved management protocols for acute PDVT and DDVT are on the horizon.

Conclusions: Advancements in endovascular approaches to thrombectomy and anticoagulation have broadened treatment options for both PDVT and DDVT. DVT and its complication, PTS, represent a substantial global healthcare and economic burden. Further research and large-scale trials are essential to optimize treatment paradigms, minimize time to complete VTE resolution, and reduce endothelial damage and systemic anticoagulant exposure.