Fragile flow: Deep vein thrombosis and interventions in an aging vascular landscape

As the global population ages, the management of deep vein thrombosis (DVT) in older adults presents unique challenges, including higher incidence, and increased morbidity from post-thrombotic syndrome (PTS), and greater complexity due to frailty and comorbidities. This review examines venous thrombectomy and related interventions for DVT in this population, integrating geriatric principles into clinical practice. The pathophysiology is exacerbated by age related changes like “inflammaging,” and atypical clinical presentations can delay diagnosis. Diagnostic approaches should be tailored, using age adjusted D-dimer thresholds and imaging modalities such as duplex ultrasound, computed tomography venography (CTV), or magnetic resonance venography (MRV). Treatment requires balancing procedural efficacy against heightened risks. While anticoagulation, particularly with direct oral anticoagulant (DOACs), is the main stay of therapy, it requires a careful dosage adjustment for renal function. Endovascular options like catheter directed thrombolysis (CDT) and pharmacomechanical thrombectomy (PMT) can restore patency but carry significant bleeding risks. Central theme for managing this population is a holistic assessment beyond DVT, evaluating frailty, polypharmacy, and cognitive status to stratified risk. Shared decision-making that alliance interventions with patient specific goals is paramount. Age alone should not be a barrier to intervention. A patient-centered, multidisciplinary approach that integrate vascular expertise with geriatric principles can lead to safer procedures and improved functional outcomes. Future research should prioritize quality-of-life metrics to ensure treatment enhances patient independence and aligns with what matters most to the patient.