Comparison of non-contrast, non-radiation percutaneous mechanical thrombectomy and catheter-directed thrombolysis in pregnancy-associated iliofemoral deep vein thrombosis: a propensity-matched retrospective cohort study

Abstract

Iliofemoral deep vein thrombosis (DVT) during pregnancy poses considerable risks to both the mother and the fetus, making it essential to provide prompt, effective, and safe treatment options. Although catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT) present promising alternatives to systemic anticoagulation, there is a lack of comparative data regarding their application during pregnancy, particularly concerning non-radiation and non-contrast protocols. This study aims to compare the safety and efficacy of PMT, which does not involve radiation or contrast, against CDT for treating iliofemoral DVT in pregnant patients. We conducted a retrospective cohort study that focused on pregnant patients diagnosed with iliofemoral deep vein thrombosis (DVT) who received non-contrast, non-radiation endovascular interventions between 2018 and 2023. The patients were divided into two groups: the percutaneous mechanical thrombectomy (PMT) group and the catheter-directed thrombolysis (CDT) group. To ensure that the baseline characteristics of the two groups were comparable, we utilized propensity score matching at a 1:1 ratio. The primary outcomes we measured were the effectiveness of thrombus clearance and the rate of vein patency after 12 months. Additionally, we assessed several secondary outcomes, including the occurrence of bleeding events, the development of post-thrombotic syndrome (PTS), and various indicators of maternal and fetal safety. A total of 58 pregnant patients participated in the study, with 29 in the PMT group and 29 in the CDT group after matching. The results indicated that PMT eliminated the need for catheter-directed thrombolytic infusion, whereas the median thrombolysis duration in the CDT group was 49 h ( p < 0.001). Additionally, the hospital stay was shorter for the PMT group, with a median of 7 days versus 10 days for the CDT group ( p < 0.001). Despite these differences in procedure duration and hospital stay, the primary patency rates at 12 months were comparable for both groups, each at 51.7%. Importantly, there were no reported cases of major bleeding or fetal compromise in either group. The incidence of post-thrombotic syndrome (PTS) was also similar between the two groups, with rates of 31.0% in the PMT group and 34.5% in the CDT group. Both PMT and CDT appeared feasible and were associated with favorable short-term maternal and fetal outcomes in this cohort. PMT, in particular, presents advantages in procedural efficiency, making it a viable and possibly more favorable choice for treatment. However, further prospective studies are needed to provide more comprehensive data that can guide future clinical practice guidelines.