Mechanical Thrombectomy for Post-Thrombotic Venous Obstruction is Associated with Venous Wound Healing

To evaluate the association between mechanical thrombectomy (MT)-combined with standard wound care and adjunctive endovenous interventions, as indicated-and venous wound healing in patients with post-thrombotic venous obstruction.

This multicenter, retrospective analysis included adults with venous wounds secondary to lower extremity deep vein thrombosis (DVT). MT was performed with one or more of the following devices (Stryker, Irvine, CA): ClotTriever System, ClotTriever BOLD catheter, or VenaCore catheter in native vessels, or RevCore catheter within occluded stents. Adjunctive venoplasty and stenting were performed as indicated. Standard wound care continued until wound healing or latest follow-up. Technical success was defined as crossing the lesion and deploying the study device; clinical success as any decrease from baseline in wound area.

Twenty-two patients with 37 wounds on 29 limbs were treated between August 2021 and September 2024. Mean age was 59.0 ± 12.8 years and 72.7% were male. More than half had failed conservative wound care prior to referral; three had been referred for amputation. Median wound duration was 13.0 [interquartile range (IQR) 6.3-45.0] months. Technical success was achieved in 100% of cases; all procedures were single session, with 91.7% performed outpatient. Stenting was performed in 15 of 29 limbs (51.7%) and venoplasty in 23 of 29 (79.3%). Among the 14 limbs without new stenting at the index procedure, 2 underwent MT alone and 11 received adjunctive venoplasty only. No adjunctive thrombolytics were used. Hospital stay (median 2 [IQR 2-2.75] days) was required following 6 procedures. At latest follow-up (median 2.8 [IQR 2.0-3.5] months), all wounds were healed or healing, meeting the clinical success definition. Among the 25 wounds with available area data, mean wound area decreased from 22.0 ± 30.9 cm² at baseline to 5.1 ± 20.8 cm², with a mean per-wound area reduction of 91.4%; 76% (19/25) fully healed and the remaining wounds showed a mean per-wound area reduction of 65.6%.

In this multicenter retrospective analysis, all patients with post-thrombotic venous wounds were healed or healing at latest follow-up after MT, with a 91% mean per-wound area reduction. These findings suggest that MT-combined with standard wound care and adjunctive endovenous interventions as indicated-may play an important role in treating recalcitrant post-thrombotic venous wounds.