Stent Procedure Eases Post-Thrombotic Syndrome After DVT

Key Takeaways

• In a randomized trial, severe post-thrombotic syndrome was less common at six months in the endovascular-treatment group (iliac vein stenting plus enhanced antithrombotic therapy) than in the standard-treatment group.
• The study enrolled patients with prior deep vein thrombosis, ongoing disability, and iliac vein obstruction across 29 U.S. sites.

The intervention involved placing a mesh tube within the affected vein to reopen narrowed flow and support the vessel wall, with the goal of restoring blood flow through a vein damaged by earlier clot-related obstruction.

The NIH-sponsored C-TRACT trial enrolled 225 patients across 29 U.S. sites after at least 3 months of treatment for deep vein thrombosis. Participants had substantial iliac vein obstruction involving a major pelvic vein and meaningful disability related to post-thrombotic syndrome at enrollment. Enrollment focused on patients with clinically important residual venous blockage and marked functional limitations despite prior treatment. One group was assigned to venous stenting plus standard compression therapy and blood-thinning medication used for ongoing management, while the comparison group received standard treatment alone (compression and blood-thinning therapy) without stent placement.

At six months, severe post-thrombotic syndrome persisted in 40% of the stent group and 61% of the standard-care group. The study also reported a 14-point advantage for the stent group on a 100-point quality-of-life scale, based on patient-reported measures collected at follow-up. At the same time point, the comparison captured both persistence of severe syndrome and change in health-related quality of life. Overall, the procedural arm showed lower symptom burden at six months than standard care.

Patients who received stents also reported better leg-vein symptoms and better overall quality of life than those given standard treatment alone, matching the directional pattern across the trial’s six-month assessments.

Bleeding was more common in the endovascular-treatment group, driven primarily by nonmajor bleeding associated with intensified antithrombotic therapy