BackTable Vascular & Interventional Ep. 594 How New Guidelines are Shaping Acute DVT Management with Dr. Steven Abramowitz
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Dec 2, 2025 Dr. Steven Abramowitz, a vascular surgeon and physician executive director at MedStar, discusses the latest guidelines on deep venous thrombosis (DVT) management. He delves into the implications of the ATTRACT trial and the CLOUT registry, emphasizing how mechanical thrombectomy is evolving. Abramowitz highlights key techniques like IVUS for treatment endpoint determination and the importance of collaboration with referring physicians. He also touches on the role of anticoagulation and the need for redefining DVT to improve patient outcomes.
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Mechanical Thrombectomy Changed Guideline Views
- Mechanical and aspiration thrombectomy shifted guideline thinking after ATTRACT by showing effective non-lytic options.
- CLOUT's propensity-matched data pushed societies to consider mechanical intervention for iliofemoral DVT as first-line in some patients.
Target Low Residual Thrombus As Endpoint
- Aim for a technical endpoint with minimal residual thrombus because residual clot in inflow segments links to worse long-term outcomes.
- Use the operator's judgment to choose single- or multi-session therapy to achieve that endpoint.
Trial Endpoints Don't Match IVUS Reality
- Core labs use the MARTER venographic score as the trial technical endpoint, which ignores IVUS findings.
- There is no standardized IVUS-based thrombus scoring system, causing a mismatch between trial endpoints and intraoperative assessment.