Short-term outcomes of aspiration thrombectomy and iliac vein intervention for deep vein thrombosis at Dong Nai General Hospital

Abstract

Background: Iliofemoral deep vein thrombosis (DVT) carries the lowest spontaneous recanalization rate and the highest risk of post-thrombotic syndrome. Mechanical aspiration thrombectomy combined with iliac vein intervention removes thrombus and corrects the underlying obstructive lesion without prolonged thrombolytic infusion. This technique was introduced at Dong Nai General Hospital in April 2025.

Methods: A retrospective case series of 19 consecutive patients with iliofemoral DVT treated by percutaneous mechanical aspiration thrombectomy with iliac vein balloon angioplasty and/or stenting between April 2025 and September 2026. Endpoints were technical success, degree of recanalisation on digital subtraction venography, in-hospital complications and early re-occlusion.

Results: Mean age was 47.1 ± 14.7 years (range 27 – 81); 17/19 (89.5%) were women. All thrombi involved the iliofemoral segment. No patient had prolonged immobilisation, recent surgery, malignancy or previous venous thromboembolism. May-Thurner syndrome was suspected on imaging in 13/19 (68.4%). Aspiration thrombectomy alone was performed in 14/19 (73.7%) and combined with alteplase in 5/19 (26.3%). Iliac vein angioplasty was performed in 17/19 (89.5%) and stenting in 13/19 (68.4%). Treatment was completed within a single session in 17/19 (89.5%). Mean procedure time was 83.7 ± 23.1 minutes. Technical success was achieved in 18/19 (94.7%), with complete recanalisation in 10/19 (52.6%) and partial recanalisation in 8/19 (42.1%). No bleeding, pulmonary embolism, access-site complication or in-hospital death occurred. Early re-occlusion was observed in 5/19 (26.3%). Median hospital stay was 7 days. Direct oral anticoagulants accounted for 84.2% of post-procedural regimens.

Conclusions: Aspiration thrombectomy with iliac vein intervention is feasible and safe in a provincial hospital setting, with a high technical success rate and no major in-hospital complications. The early re-occlusion rate (26.3%) reflects the initial challenges during early implementation, highlighting the need to standardize stenting criteria, optimize stent sizing, and establish objective parameters for residual stenosis.