February 20, 2020
Outcomes in Postpartum Women After CDT and Stenting for Iliofemoral DVT
February 20, 2020—The Society for Vascular Surgery (SVS) announced that findings from a single-center review of postpartum women undergoing catheter-directed thrombolysis (CDT) and stenting for acute iliofemoral deep vein thrombosis (DVT) may be more likely to experience stent occlusion and require reintervention. Katalin Lestak, MBBS, et al published the study in SVS’s Journal of Vascular Surgery: Venous and Lymphatic Disorders (2020;8:167–173).
As noted in the SVS announcement, pregnancy increases the risk of venous thromboembolism (VTE) fourfold to fivefold, and thrombotic events are the leading cause of maternal mortality. Up to 70% of peripartum patients report symptoms of postthrombotic syndrome (PTS) and a poorer quality of life after a VTE event.
Stephen Black, MBBS, is the Principal Investigator of the study. Dr. Black and Dr. Lestak are from King’s College London in the United Kingdom. The investigators stated that this study provides a glimpse into the outcomes of therapy for this understudied patient population.
According to the SVS, this retrospective study encompassed all postpartum patients treated for acute iliofemoral DVT with lysis and stenting between 2012 and 2017. Characteristics of the 11 postpartum women studied included a median age of 28 (range, 22–41 years) and intervention performed at a median of 3 weeks (range, 2–12 weeks) after birth.
Patients experienced no major or minor complications during treatment, mild symptoms of PTS (in two patients), and no moderate or severe symptoms of PTS. However, compared with a control group of 68 nonpostpartum women undergoing similar treatment, the study population experienced worse cumulative stent patency (64% vs 93% at 1 year) and higher reintervention rate (6 vs 20 at 1 year).
Dr. Lestak commented in the SVS press release, “Despite the benefits of early CDT and stenting for iliofemoral DVT in nonpregnant women, subcutaneous and oral anticoagulation continues to be the most used form of treatment in pregnancy and the puerperium, owing to perceived increased risks to mother and fetus.”
She continued, “Due to a lack of inclusion of pregnant patients in large randomized trials, including the most recent ATTRACT study, data [are] scarce for this patient population. Our study characterizes the management of these patients by examining the outcomes of postpartum women with iliofemoral DVT who underwent percutaneous thrombolysis and stenting.”
Also in the SVS announcement, Dr. Black stated, “Acute iliofemoral DVT and severity of PTS continue to be a significant problem within the pregnant and postpartum population. Percutaneous intervention provides a favorable alternative to conservative therapies owing to its potential to decrease the severity of PTS in a young and at-risk population.”
In studying mechanisms for stent failure in this population, Dr. Black noted a higher incidence of incomplete clot lysis and removal. He stated, “Completion of lysis and adequate stenting of disease is essential to prevent reocclusion for which reintervention carries a lower likelihood of success.”