Background Adolescents who develop extensive lower extremity deep venous thrombosis (DVT) are at high-risk for adverse outcomes including post-thrombotic syndrome (PTS) with anticoagulation alone. New mechanical thrombectomy devices, such as the ClotTriever® device, have been reported to reduce PTS in adults, however, there is limited data in adolescents with lower extremity DVT. Aim To assess outcomes of adolescents post-mechanical thrombectomy with a ClotTriever® device for extensive lower extremity DVT in a multisite Canadian cohort. Methods Adolescents (age 10- < 18 years) who underwent mechanical thrombectomy with a ClotTriever® device for extensive lower extremity DVT between 01/2023–03/2026 at 5 Canadian centres were reviewed retrospectively. Data collected included demographics, DVT symptoms/risks, imaging, anticoagulation, procedure details and bleeding (major and clinically relevant non-major (CRNM)). Outcomes on imaging and PTS assessments (CAPTSure© score) were completed at 6 and/or ≥12 months post-thrombectomy. Results Twenty-one patients were identified with 20/21 undergoing thrombectomy <2 weeks from symptom onset. 20/21 had follow-up imaging after anticoagulation therapy with 12/20 showing full resolution of thrombus. No patients had major or CRNM bleeding post-thrombectomy even with intensive periprocedural anticoagulation. All patients completed PTS assessments with CAPTSure© scores at 6 and/or ≥12 months post-thrombectomy (median 12 months) with 19/21 having no PTS, 1/21 having mild PTS and 1/21 having moderate-severe PTS. Conclusions Results suggest adolescents with extensive lower limb DVT who underwent thrombectomy with ClotTriever® in combination with anticoagulation had a high rate of thrombus resolution and a low rate of PTS. Lack of bleeding events may be an advantage over endovascular thrombolysis in this population.
Background Residual pulmonary vascular obstruction (RPVO) after pulmonary embolism (PE) is common and has been associated with adverse outcomes, although its independent prognostic significance remains uncertain. Objectives To investigate whether perfusion defects are independently associated with long-term mortality after PE, and secondarily to assess their relationship with dyspnoea severity. Methods In this nationwide cohort study, Swedish patients with PE in 2005 who survived to 2007 underwent structured follow-up including symptom assessment and clinical evaluation. Ventilation–perfusion (V/Q) scintigraphy was recommended based on clinical judgement. V/Q scintigraphy findings were classified as normal or perfusion defects. To account for selection bias into scintigraphy, inverse probability weighting (IPW) was applied. Survival was analysed using IPW-weighted Cox regression with delayed entry at scintigraphy. Results Among 911 patients eligible for scintigraphy, 523 underwent examination; 513 with normal findings or perfusion defects were included in the analyses. Median time from PE to scintigraphy was 6.3 years, with 8.8 years of follow-up thereafter. Perfusion defects were present in 221 patients (43%). Dyspnoea severity was not associated with perfusion defects in unadjusted or adjusted analyses. In unadjusted analyses, perfusion defects were associated with lower survival (log-rank p = 0.049). However, this association was attenuated after adjustment and was not independently associated with mortality in IPW-weighted Cox regression (hazard ratio 1.28, 95% confidence interval 0.94–1.74). Conclusions Perfusion defects were associated with mortality in unadjusted analyses but not after adjustment for age and comorbidities, suggesting that their apparent prognostic impact largely reflects underlying patient characteristics rather than an independent effect.
Background The effects of venous thromboembolism (VTE) on mental health have gained increasing awareness. We aimed to conduct a scoping review of the qualitative and quantitative evidence of mental health after VTE. Materials and methods We conducted a systematic search of MEDLINE, Embase, CINAHL, and PsycInfo. The qualifying participant criteria was a VTE diagnosis, the principal concept was mental health. Studies investigating quality of life without a specific mental health focus were excluded. The outcome assessment was not restricted to specific methods. Quantitative analyses were not performed. Results Of 11,947 identified records, 104 were included. The first record dates to 1931, with a steep publication increase in the 2010s. Qualitative and mixed-methods studies (n = 37) were mostly conducted in high income countries and included vulnerable patient populations. Quantitative studies (n = 64) primarily focused on anxiety or depression but showed a high degree of heterogeneity. Several studies included VTE patients only as subgroups and no study was dedicated to prevention or treatment. We identified the following research gaps and recommendations: (1) harmonization of outcomes; (2) longitudinal outcome assessment; (3) expansion to vulnerable patient populations, such as patients with cancer, and lower income countries; (4) assessment and/or exclusion of pre-existing diagnoses or assessment of pre-VTE mental health; and (5) dedicated studies evaluating prevention and treatment of mental health disorders after VTE. Conclusions Mental health sequelae after VTE have been investigated in various qualitative and quantitative studies. However, these studies are characterized by considerable heterogeneity and their clinical impact is limited due to the lack of investigations of prevention or treatment of mental health disorders after VTE.
