Patient Selection and Evidence for Intervention in Deep Vein Thrombosis and Pulmonary Embolism

Intervention for deep vein thrombosis (DVT) and pulmonary embolism (PE) should address a clinical problem that anticoagulation alone may not resolve. This narrative review separates whether to intervene, which procedure to choose, and how to maintain benefit. The review covers publications through 10 September 2026, with a later STORM-PE follow-up report identified separately. Anticoagulation remains foundational. In acute iliofemoral DVT, selected patients may gain earlier symptom relief or less severe post-thrombotic disease, but trials do not support routine thrombus removal. In established post-thrombotic obstruction, C-TRACT showed better six-month clinical severity and quality of life with stenting and enhanced antithrombotic treatment, alongside more bleeding. In selected stable PE, HI-PEITHO reduced a seven-day clinical composite from 10.3% to 4.0%, mainly through fewer episodes of decompensation; a survival benefit remains unproven. Procedure comparisons and imaging trials answer narrower questions than benefit over medical care. Limb-threatening DVT and unstable PE require urgent rescue assessment. A five-scenario table and clinical examples connect this evidence to symptoms, anatomy, recovery goals, bleeding risk, and the feasibility of continuing treatment and follow-up.