The Impact of Successful Ultrasound-Accelerated Catheter-Directed Thrombolysis on the Prevention of Post-Thrombotic Syndrome: A Post-Hoc Analysis of the CAVA-Trial

P. Notten^1,2, C. Arnoldussen^3,4, R. Brans³, A. de Smet⁵, L. Tick⁶, M. van de Poel⁷, O. Wikkeling⁸, L.-J. Vleming⁹, A. Koster¹⁰, K.-S. Jie¹¹, E. Jacobs¹², H. Ebben¹³, N. Planken¹⁴, C. Wittens¹⁵, H. ten Cate^2,16,17, A.J. ten Cate-Hoek^2,16,17

¹Maastricht University Medical Center (MUMC+), Heart+Vascular Center, Vascular Surgery, Maastricht, the Netherlands, ²Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands, ³Maastricht University Medical Center (MUMC+), Radiology, Maastricht, the Netherlands, ⁴Viecuri Medical Center, Radiology and Nuclear Medicine, Venlo, the Netherlands, ⁵Maasstad Hospital, Vascular Surgery, Rotterdam, the Netherlands, ⁶Maxima Medical Center, Internal Medicine, Eindhoven, the Netherlands, ⁷Laurentius Hospital, Internal Medicine, Roermond, the Netherlands, ⁸Nij Smellinghe Hospital, Vascular Surgery, Drachten, the Netherlands, ⁹Haga Hospital, Internal Medicine, The Hague, the Netherlands, ¹⁰Viecuri Medical Center, Internal Medicine, Venlo, the Netherlands, ¹¹Zuyderland Medical Centre, Internal Medicine, Sittard, the Netherlands, ¹²Elkerliek Hospital, Internal Medicine, Helmond, the Netherlands, ¹³Amsterdam University Medical Centers, Vascular Surgery, Amsterdam, the Netherlands, ¹⁴Amsterdam University Medical Centers, Radiology and Nuclear Medicine, Amsterdam, the Netherlands, ¹⁵Maastricht University, Emeritus Professor of Venous Surgery, Maastricht, the Netherlands, ¹⁶Maastricht University Medical Center (MUMC+), Laboratory for Clinical Thrombosis and Haemostasis, Maastricht, the Netherlands, ¹⁷Maastricht University Medical Center (MUMC+), Heart+Vascular Center, Thrombosis Expertise Centre, Maastricht, the Netherlands

Abstract Number: PB2206

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » Post-thrombotic Syndrome

Background: The CAVA-trial did not show the anticipated risk reduction for post-thrombotic syndrome (PTS) after early thrombus removal via additional ultrasound-accelerated catheter-directed thrombolysis (UACDT) in patients with acute iliofemoral deep-vein thrombosis (IFDVT). Difficulties in achieving an effective degree of recanalization trough thrombolysis may have influenced these outcomes.

Aims: We aimed to assess whether successful thrombolysis with restored patency did reduce the risk of PTS. In addition, we explored determinants of successful thrombolysis and the impact on health related quality of life (QoL).

Methods: A post-hoc analysis of the CAVA-trial was performed to assess the impact of successful UACDT on the development of PTS. The proportion of PTS at 1 year follow-up was compared between patients with successful thrombolysis and patients that received standard treatment only. In addition, clinical success was determined using the Venous Clinical Severity Score (VCSS) and QoL-measures.

Results: UACDT was initiated in 77 (50.7%) patients, of which 41 (53.2%) procedures were considered successful (inter-rater agreement κ=0.69, 95%CI 0.47-0.83). A total of 75 patients received standard treatment only (49.3%). PTS developed in 48 (41.4%) patients: 15 (36.6%) in the successful thrombolysis group versus 33 (44.0%) in the standard treatment group (p=0.44). Successful thrombolysis was associated with lower VCSS (3.50±2.57 versus 4.82±2.74, p=0.02) and higher EQ5D-scores (40.2±36.4 versus 23.4±34.4, p=0.01). Compared to unsuccessful thrombolysis, successful thrombolysis was associated with a shorter symptom duration at inclusion (p=0.05), and higher rates of performed adjunctive procedures (p< 0.001), and stent placement
(p< 0.001).

Conclusions: Successful thrombolysis was not associated with a reduced proportion of PTS 1 year after acute IFDVT compared to patients receiving standard treatment alone. There was however a significant reduction in symptom severity and improvement of generic QoL. Better patient selection and optimization of treatment protocols is needed to achieve the full potential of UACDT for the prevention of PTS.

To cite this abstract in AMA style:

Notten P, Arnoldussen C, Brans R, de Smet A, Tick L, van de Poel M, Wikkeling O, Vleming L-, Koster A, Jie K-, Jacobs E, Ebben H, Planken N, Wittens C, ten Cate H, ten Cate-Hoek AJ. The Impact of Successful Ultrasound-Accelerated Catheter-Directed Thrombolysis on the Prevention of Post-Thrombotic Syndrome: A Post-Hoc Analysis of the CAVA-Trial [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/the-impact-of-successful-ultrasound-accelerated-catheter-directed-thrombolysis-on-the-prevention-of-post-thrombotic-syndrome-a-post-hoc-analysis-of-the-cava-trial/. Accessed January 21, 2022.

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