Abstract
Background and Objectives: Deep venous thrombosis (DVT) is associated with pulmonary embolism and long-term complications such as post-thrombotic syndrome (PTS). Anticoagulation prevents thrombus extension but does not actively remove clot. Interventional techniques, including catheter-directed thrombolysis, mechanical and pharmacomechanical thrombectomy, and venous stenting, have been introduced to restore venous patency and reduce complications. This systematic review summarizes current evidence on outcomes, safety, and patient selection for these procedures. Materials and Methods: A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted for studies published between January 2000 and February 2024. Eligible studies included randomized controlled trials, systematic reviews, meta-analyses, and observational studies with ≥20 patients. Extracted outcomes were technical success, thrombus clearance, venous patency, PTS, quality of life, and complications. Risk of bias was assessed using the Cochrane Risk of Bias Tool, Newcastle-Ottawa Scale, and AMSTAR-2. Results: Of 456 records screened, 35 studies were included. Randomized trials (CaVenT, ATTRACT, CAVA) showed that catheter-directed and pharmacomechanical approaches improved venous patency and reduced moderate-to-severe PTS in selected patients with iliofemoral DVT, though overall benefit was variable. Mechanical thrombectomy devices (e.g., AngioJet, ClotTriever, FlowTriever) achieved high thrombus clearance and shorter procedural times, with device-specific complication profiles. Observational data demonstrated venous stenting patency rates of 74-89% at 12 months. Study heterogeneity limited direct comparisons. Conclusions: Interventional procedures can reduce PTS and improve outcomes in carefully selected patients, particularly those with acute iliofemoral DVT. Modern mechanical and pharmacomechanical techniques enhance efficiency and safety, while venous stenting addresses underlying obstructions. Further high-quality trials with long-term follow-up are needed to define optimal patient selection and comparative effectiveness.