Long-term outcomes of infrapopliteal versus popliteal venous access for percutaneous mechanical thrombectomy in acute deep vein thrombosis: A propensity score-matched retrospective cohort study

BackgroundDespite anticoagulation, 50% of proximal deep vein thrombosis (DVT) cases progress to post-thrombotic syndrome (PTS). While percutaneous mechanical thrombectomy (PMT) reduces thrombotic burden, optimal venous access selection (popliteal vs infrapopliteal) remains unestablished. This study compares long-term outcomes between these approaches.MethodsA retrospective cohort of 56 acute DVT patients (28 per group) underwent propensity score matching for age, sex, symptom duration, and thrombus extent. All received PMT via either infrapopliteal access or popliteal access at a tertiary center (2021-2024). Primary outcomes included PTS incidence and access site complications.ResultsPopliteal access demonstrated shorter establishment time (15 vs 22.5 min, p < .01), while infrapopliteal access preferentially utilized the peroneal vein (69.2%). No intraoperative complications; minor postoperative events occurred in 5.4% (3/56) without intergroup difference. 48 patients (85.7%) completed ultrasound surveillance (mean follow-up: 21.4 ± 12.4 months). PTS rates were significantly lower with infrapopliteal access (12.5% vs 41.7%, p = .023), with a markedly lower incidence of moderate-to-severe PTS (Villalta ≥10) in the infrapopliteal group (4.2% vs 25.0%, p = .097). These benefits were observed despite comparable residual thrombosis (70.8% overall) and DVT recurrence (12.5%).ConclusionInfrapopliteal PMT, with selective adjunct CDT, is associated with a lower risk of PTS compared to popliteal access, likely due to more complete distal thrombus clearance. Despite longer access times, this approach demonstrates favorable long-term outcomes and represents a viable alternative for DVT management.