370 - Recurrence After DVT Intervention: Comparing Aspiration, Coring, and Thrombolysis Approaches in a Single-Center Ultrasound Follow-Up Study

Purpose: Deep venous thrombosis (DVT) treatment remains challenging. While catheter-directed thrombolysis (CDT) has been the traditional therapy, mechanical thrombectomy (MT) is increasingly employed. MT devices include aspiration-based systems (FlowTriever) and coring-based systems (ClotTriever). Concerns exist that mechanical devices, specifically coring devices, may damage valves and predispose to recurrence. This study evaluated ultrasound (US) follow-up after CDT and MT for recurrence, chronicity, and segmental distribution.

Materials and Methods: This single-center retrospective study included 63 patients treated for iliofemoral or more central DVT (2013–2018). Follow-up duplex US was available in 49 patients. MT was performed in 29 patients (ClotTriever n=17, FlowTriever n=8, AngioJet n=4) and CDT in 20 patients (EKOS, UniFuse, Cragg-McNamara). Recurrence, chronicity, and segmental involvement were classified from ultrasound findings. Chronicity was defined as acute, sub-acute, or chronic. Segments were grouped as iliofemoral or other (popliteal/below-knee). Comparisons were made between MT vs CDT, ClotTriever vs FlowTriever, and ClotTriever vs CDT using Fisher’s exact test.

Results: Overall recurrence was observed in 26/49 patients (53.1%). Of these, 8 were acute (16.3%), 7 sub-acute (14.3%), and 13 chronic (26.5%). Recurrences were evenly distributed: iliofemoral 19/49 (38.8%), popliteal/below-knee 19/49 (38.8%). MT and CDT showed equivalent recurrence (52% vs 55%, p=0.69), chronicity, and segmental distribution. ClotTriever and CDT also demonstrated similar recurrence (65% vs 55%, p=0.74) and no differences in chronicity or segmental involvement. FlowTriever showed fewer recurrences than ClotTriever (25% vs 65%, p=0.097), though not statistically significant.

Conclusion: In this cohort, overall recurrence remained high, underscoring the aggressive nature of iliofemoral DVT. New mechanical thrombectomy devices demonstrated outcomes comparable to CDT, which has traditionally been considered a “gentler,” pharmacologic approach. Importantly, the coring-based ClotTriever did not perform worse than CDT, providing no signal that its mechanism leads to higher recurrence or valvular injury. In contrast, the aspiration-based FlowTriever demonstrated lower recurrence than ClotTriever, though this did not reach statistical significance. Collectively, these findings suggest equivalence between MT and CDT, with no evidence of valvular damage from coring devices, and highlight aspiration-based MT as a promising approach for further study.