Institute (NHLBI), a part of the U.S. National Institutes of Health (NIH).
Investigators followed 692 patients for 2 years and found that among patients with acute DVT, the addition of PCDT to anticoagulants did not lower the risk of post-thrombotic syndrome, but did result in a higher risk of bleeding. However, according to researchers, the study indicated that while not a first-line treatment for DVT, the use of anticoagulants and PCDT could be beneficial with careful patient selection.
Not only has the ATTRACT trial been lauded for its structure, collaboration and scope, but it has paved the way for future research and created a pathway for large-scale, IR studies.
“Becoming an NIH researcher was like bumping my head in a million places as I tried to find my way through, and it took energy, creativity, adaptability and a lot of help,” said Dr. Vedantham. “But in the process, I’ve learned a lot about how an IR can become a clinical scientist who advances care, leads studies, and is trusted to lead guideline panels and other rigorous endeavors in multispecialty forums.”
READ MORE Weinberg I, Vedantham S, et al. Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial. Vasc Med. 2019 Oct;24(5):442-451.
The C-TRACT trial Purpose: To determine the ability of endovascular therapy (EVT) to reduce the severity of postthrombotic syndrome (PTS) in patients with moderate-to- severe PTS due to previous deep vein thrombosis.
The Chronic Venous Thrombosis—Relief with Adjunctive Catheter-Directed Therapy (C-TRACT) trial is a multicenter, randomized controlled trial funded by the NIH NHLBI. Though the design of C-TRACT was modeled after ATTRACT and the data from that trial informed
Want to review more of the landmark studies, papers and research that have shaped IR for over 50 years? Check out some recommended reading below:
Crockett MT, Browne RF,
MacMahon PJ, Lawler L. 100 classic papers of interventional radiology: A citation analysis. World J Radiol. 2015 Apr 28;7(4):79-86.
Plus: In 2015, JVIR collated the landmark IR papers to celebrate 25 years of the journal. Check out the special issue and articles below.
READ MORE Vedantham S, Parpia S, Kahn SR. A Clinical Trial of Venous Stent Placement for Post-thrombotic Syndrome: Current Status and Pandemic- related Changes. Vasc Endovasc Rev. 2022 Feb;5:e06.
PRESERVE Purpose: To determine the safety and effectiveness of vena cava filters.
The Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE) trial is the largest multispecialty, prospective, pragmatic clinical research trial to date to evaluate the real-world safety and effectiveness of inferior vena cava (IVC) filters.
The trial was sponsored by the IVC Filter Study Group Foundation, a nonprofit research arm of the joint efforts of SIR and the Society for Vascular Surgery (SVS) and led by Co-principal Investigators Matthew S. Johnson, MD, FSIR, and David L. Gillespie, MD.
the investigation, the two trials have key differences. Where ATTRACT focused on evaluating up-front treatment for acute DVT, C-TRACT investigates whether catheter-directed thrombolytic therapy should be a routine treatment for large scale DVT. C-TRACT focused on a narrower patient population.
“Patients with PTS exhibit substantial disability, but on a spectrum,” Dr. Vedantham said. “While some only have mild disease, many have significant pain, swelling or leg ulcers. Part of the problem is that they may have blockages, residual clots or narrowing of their veins.” Over the years, Dr. Vedantham said, IRs have found that placing stents did lead to clinical improvement—but this was anecdotal evidence, as no large-scale studies had been conducted to determine whether the risk of the device placement had substantial long-term benefits.
C-TRACT is still enrolling, with an aim at 374 patients. Currently, almost 30 sites are participating.
1993 Expanding membership 2,120
SCVIR membership reaches 2,120. Membership expands to include first- and second-year residents. The annual meeting becomes so large it moves to a convention center.
16 IRQ | WINTER 2025
“There is a real hole in our understanding of IVC filters,” said Dr. Johnson. “Hundreds of thousands of people die every year from pulmonary embolus. It’s a huge health issue. And while most of the time patients are treated with anticoagulation, many cannot receive that standard of care, which is why IVC filters became a popular alternative.”
However, following a 2012 FDA public health advisory that advised the removal of retrievable IVC filters, PRESERVE was formed to provide real-world data on the safety, efficacy and necessity of IVC placement.
Between 2015 and 2019, PRESERVE enrolled 1,428 patients and placed filters in 1,421. The primary safety endpoint (89.4%) and primary effectiveness endpoint (96.4%) were both achieved, and clinically significant IVC filter-related adverse events were rare.
READ MORE Johnson MS, et al. Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE): Outcomes at 12 months. JVIR. 2023 April;34(4):517-528.e6.
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