BACKGROUND: Comparison of the treatment effects of immediate stent implantation versus staged stent implantation after AngioJet mechanical thrombectomy in patients with acute iliofemoral venous thrombosis. METHODS: A study included 80 patients with acute iliofemoral venous thrombosis formed between June 2021 and February 2023. They were divided into 2 groups: the direct implantation group (37 patients, 9 males) and the staged implantation group (43 patients, 10 males). Venous angiography and Villata scoring were used to assess patency rates and the occurrence of postthrombotic syndrome (PTS). A 1-year follow-up was conducted and a multiple-factor Cox regression model was used to analyze the clinical factors affecting patency rates. RESULTS: Surgery was successfully completed without serious complications or deaths during follow-up. The direct implantation group had significantly shorter hospital stays and surgical times compared to the staged implantation group (P <
0.001). Both groups showed a decrease in Villata scores (P <
0.001), and the direct group had higher scores than the staged group at 12 months postsurgery (P <
0.001). One year after the procedure, there was no significant difference in stent patency rates (P = 0.658), but postoperative scores at 1 month (P = 0.012) and stent length (P = 0.015) had a significant impact. CONCLUSIONS: For acute iliofemoral venous thrombosis, both direct stent implantation and staged implantation are effective. The direct implantation procedure has shorter hospital stays and surgical times, whereas staged implantation has a lower long-term risk of PTS. Villata scores at 1 month after surgery can predict the risk of vascular obstruction. Longer stents may reduce the risk of postoperative obstruction.