Do treatment methods for deep vein thrombosis have different effects on post-thrombotic syndrome and the quality of life?

Abstract

Objective

This study aimed to compare the effects of interventional methods and medical therapy in patients with acute proximal deep vein thrombosis (DVT) on the risk of development of post-thrombotic syndrome (PTS) and the quality of life during the follow-up period.

Patients and methods

Clinical statuses of the patients who were treated medical therapy alone or medical therapy and endovascular treatment for acute proximal (iliofemoral-popliteal) DVT between 1st January 2014 and 1st November 2022 were reviewed retrospectively. The study included 128 patients who received interventional treatment (Group I) and 120 patients who received medical therapy alone (Group M). The mean age of the patients was 52.98 ± 12.45 years in Group I and 55.60 ± 16.15 years in Group M. Patients were classified as provoked or unprovoked and by LET scale (lower extremity thrombosis level scale). Patients were followed-up for 1 year using Villalta scores and VEINES-QoL/Sym questionnaire. LET scale was evaluated based on the results of lower extremity venous Doppler ultrasound (DUS).

Results

No early acute phase mortality was observed. LET classification showed that there is higher proximal involvement in Group I (Table 1 Table 1.

Demographic data.

	Group G (n = 128, %)	Group M (n = 120, %)	p
Age(years) mean ± SD	52.98 ± 12.45	55.60 ± 16.15	0.152
Gender(F/M),n	57/71	58/62	0.548
LET classification n (%)
Class 1	0	30 (25)
Class 2	19 (14.9)	66 (55)
Class 3	99 (77.3)	24 (20)
Class 4	10 (7.8)	0
BMI (kg/m2) (mean ± SD)	26.61 ± 4.05	27.86 ± 3.46	0.746
Smoking n (%)	71 (56.25)	89 (74.16)	0.649
DM n (%)	16 (12.5)	20 (16.66)	0.845
HT n (%)	41 (32.03)	29 (24.16)	0.950
Kidney failure n (%)	3 (2.34)	2 (1.66)	0.963
Lateralization n (%)
Right	66 (51.56)	62 (51.66)	0.987
Left	62 (48.44)	58 (48.34)
DVT development n (%)
Provoked	52 (40.62)	57 (47.5)	0.546
Unprovoked	76 (59.38)	63 (52.5)
Ulcer	10	13	0.412

). Recurrence rate was 6.25% (8 patients) in Group I and 21.66% (26 patients) in Group M (p < .001). Pulmonary embolism was not observed in either group. At 12-month follow-up, the number of patients with a Villalta score of ≥5 was 8 (6.25%) in Group I and 81 (67.5%) in Group M (p < .001), while the mean VEINES-QoL/Sym scale score was found to be 72.5 ± 6.35 in Group I and 40.2 ± 9.31 in Group M (p < .001). The rates of anticoagulant-associated bleeding were 3.12% (4 patients) in Group I and 6.66% (8 patients) in Group M. The mean complete recanalization rates calculated using DUS at year 1 was found to be 63.28% (81 patients) in Group I and 9.16% (11 patients) in Group M (p < .001).

Conclusion

When deep vein thrombosis is treated using interventional methods, lower Villalta scores are detected after 1 year of follow-up. Development of post-thrombotic syndrome is reduced substantially. According to VEINES-QoL/Sym quality of life (QoL) scale, QoL is higher in patients who underwent interventional procedures. Interventional treatment provides persistent benefit in the short and medium terms especially in DVT with proximal involvement.