Endovascular therapy may benefit patients with post-thrombotic syndrome

New trial results suggest that patients with post-thrombotic syndrome (PTS) after deep vein thrombosis may benefit more when endovascular therapy is added to standard care. The endovascular procedure involved an iliac vein stent placement and enhanced antithrombotic therapy. People who had the endovascular procedure reported less severe post-thrombotic syndrome (PTS) and better quality of life scores at six month follow-up, compared to patients who received standard care alone. “PTS can be life-altering, yet we’ve had very few effective treatment options,” says Sameer Parpia, senior author and data coordinating centre principal investigator of the study and an associate professor in the departments of oncology and health research methods, evidence and impact at McMaster University.“This trial provides clear evidence that targeted endovascular therapy can make a meaningful difference for patients living with this condition.”Researchers from McMaster University in Hamilton, Ont., and Washington University School of Medicine in St. Louis, enrolled 225 people across 29 sites in the U.S. All participants had moderate-to-severe PTS and iliac vein obstruction confirmed with imaging. The researchers randomized participants to receive either the endovascular therapy and standard care, or standard care alone, which involved compression therapy with stockings, anticoagulants and lifestyle modifications. The researchers measured severity of PTS through the Venous Clinical Severity Score tool, which provides scores from 0 to 30, with higher scores indicating more severe PTS. At six months, patients in the endovascular therapy group had significantly lower scores of PTS severity compared to patients receiving standard care. Quality of life, measured using two difference scores, was also significantly better in the endovascular therapy group compared to standard care. The scores were the venous insufficiency epidemiological and economic study quality of life questionnaire (VEINES-QOL) and the medical outcomes study 36-item short form health status survey (SF-36) physical component summary score. There was a significantly higher rate of bleeding in the endovascular therapy group (11.6% of patients) than the standard care group (3.6% of patients). The endovascular group had more anticoagulant medications.“Our findings show that carefully performed endovascular therapy, supported by evidence-based medical management, can meaningfully reduce symptoms and improve daily functioning for patients with long-term blockages of important veins after a blood clot,” said Dr. Suresh Vedantham, lead author the study and professor of radiology and of surgery at Washington University School of Medicine. He was quoted in a McMaster University press release.The McMaster researchers honoured the contributions of Dr. Clive Kearon, a thrombosis expert who helped design the trial and secured funding. Dr. Kearon wrote about his terminal melanoma diagnosis in CMAJ before his death in Dundas, Ont. in June 2020.The results of the trial were published in the New England Journal of Medicine and presented at the Society for Interventional Radiology 2026 annual scientific meeting, held in Toronto in April.

Endovascular therapy may benefit patients with post-thrombotic syndrome

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