Abstract / Summary
Abstract Background Acute recurrent deep vein thrombosis (DVT) presents significant clinical challenges, often leading to debilitating post-thrombotic syndrome (PTS) and recurrent embolic events despite conventional anticoagulation. Catheter-directed therapies, specifically mechanical thrombectomy (MT) and venoplasty, offer immediate thrombus removal and resolution of underlying anatomical obstructions like May–Thurner syndrome (MTS). Aim and added value This multi-center study explicitly aims to evaluate real-world outcomes of a collaborative endovascular approach, providing crucial comparative data on device performance (AngioJet vs. ClotTriever) in high-risk recurrent settings. Methods This multi-center retrospective cohort study evaluates 36 patients diagnosed with MTS complicated by acute recurrent DVT. Procedures were performed collaboratively at two tertiary care centers. All patients underwent diagnostic venography, MT, percutaneous transluminal angioplasty (PTA), and self-expanding stent placement. Recruitment and criteria Patients were recruited over a defined period from January 2023 to December 2025. Inclusion criteria comprised adult patients (> 18 years) with confirmed acute/acute-on-chronic symptomatic iliofemoral DVT secondary to MTS; exclusion criteria included absolute contraindications to anticoagulation, uncorrectable coagulopathy, or life expectancy <1 year. Results Technical success (> 90% thrombus removal) was achieved in 100% of cases. Immediate clinical improvement was observed in all patients. Two patients experienced transient contrast-induced nephropathy that resolved conservatively. At mid-term follow-up, venous patency was maintained on duplex ultrasound with significant symptomatic improvement. Conclusion Collaborative endovascular management involving MT, PTA, and stenting is a highly effective treatment for extensive DVT secondary to severe MTS. Addressing both the acute thrombus and the underlying anatomical lesion is vital for preventing recurrence and PTS.