Optimizing Patient Care in Advanced Venous Disease with Mechanical Thrombectomy: A Retrospective Analysis of 91 Cases Including 31 Wounds

Introduction: Post-thrombotic syndrome (PTS) is one of the most common complications of deep vein thrombosis, affecting up to 50% of patients 1. The severity of PTS is assessed by the Villalta score, a widely adopted scoring system that evaluates various clinical signs and symp- toms, along with the presence of a venous ulcer or wound 2. Case reports have demonstrated the successful use of mechanical thrombectomy (MT) in patients with PTS to remove advanced venous occlusions 3,4. Here, we evaluate the safety and efficacy of MT devices* to remove venous occlu- sions and/or in-stent thrombosis and assess the subsequent impact on wound healing and recurrence. Methods: This multicenter, retrospective analysis included patients treated with MT between August 2021 and August 2024. Baseline, procedural, and follow-up data were collected, including patency, safety events, and ulcer characteristics. Freedom from wounds and wound recurrence were reported. Results: This analysis included 91 patients (107 limbs) with 31 wounds. The mean patient age was 56.7 ± 14.9 years, 52.7% were male, and 35.2% (32/91) of patients presented with severe PTS. All patients underwent MT with 43.5% receiving adjuvant stenting resulting in patent segments and a device-related adverse event rate of 0%. Median thrombus removal was 85% [IQR 50-90] based on imaging and physician assessment. At the latest follow-up (n=48; mean 2.6 ± 1.4 months), the adverse event rate was 0% and reintervention rate was 10.4% (5/48). The mean Villalta score decreased by 45.9% from 9.8 ± 5.1 at baseline to 5.3 ± 3.3 at follow-up. For wounds with available data (n=23), freedom from wounds was 78.3% (18/23), and the area of the 5 healing wounds reduced by 73.4%. Freedom from wound recurrence was 100%. Further data will be available for the presentation, as follow-up is ongoing. Discussion: The removal of advanced venous occlusions through MT restored patency and resulted in complete wound healing in nearly 80% of cases, with no reported wound recurrence. These findings indicate that MT is a safe and effective treatment for patients with PTS accom- panied by wounds. Thereby adopting MT, along with site-specific wound care algorithms, might be crucial for managing wounds associated with advanced venous occlusions.