Emced KHALIL
Journal of Updates in Cardiovascular Medicine - 2026;14(2):36-42
Objectives: Acute iliofemoral deep vein thrombosis (DVT) is distinguished by a pronounced symptomatology and an increased risk of post-thrombotic syndrome. Various techniques of prompt thrombus removal are intended to improve venous patency and outcomes; however, controversy still surrounds the appropriate modality of endovascular treatment and the necessity of routine stenting. In this study, we aimed to evaluate the procedural safety, efficacy, and intermediate-term outcomes of a standard stent-free pharmacomechanical thrombectomy with catheter-directed thrombolysis (PMT-CDT) in acute iliofemoral DVT. Materials and Methods: This was a retrospective single-center study of 50 consecutive patients undergoing treatment for acute iliofemoral DVT between January 2020 and December 2023. All patients underwent a standardized endovascular treatment protocol using PMT and low-dose CDT without the routine use of venous stenting. Technical success, periprocedural complications, and re-thrombosis were evaluated. Estimation of re-thrombosis-free survival was performed using Kaplan-Meier survival analysis at 3, 6, and 12 months. Results: Technical success was obtained in 46 patients (92%). There were no deaths, pulmonary embolism, and major hemorrhage. Minor complications occurred in five patients (10%) and were managed conservatively. During the period of follow-up, five patients (10%) were lost to follow-up. Kaplan-Meier estimates showed that the probability of freedom from re-thrombosis at 3 months, 6 months, and 12 months was 97.5%, 92.5%, and 87.5%, respectively. Venous stent insertion was not necessary in any patient after thrombus clearance based on venographic assessment. Conclusion: In this study, a standard stent-free PMT-CDT approach was shown to be a feasible and safe option for selected patients with acute iliofemoral DVT, with good mid-term patency results. However, these results should be interpreted with caution, as this study was descriptive in nature, without any standard evaluation of outcome, such as post-thrombotic syndrome scoring. Further prospective studies are needed to clarify the role of stent-free techniques in managing acute iliofemoral DVT.
