Comparison of catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy for subacute iliofemoral deep vein thrombosis

Abstract

Objective To evaluate and compare the treatment efficacy and safety between catheter-directed thrombolysis monotherapy and catheter-directed thrombolysis combined with percutaneous mechanical thrombectomy for patients with subacute iliofemoral deep vein thrombosis. Methods We conducted a retrospective analysis of a total of 74 subacute iliofemoral deep vein thrombosis patients who underwent catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy. Patients treated with catheter-directed thrombolysis combined with percutaneous mechanical thrombectomy (percutaneous mechanical thrombectomy group, n = 30) or catheter-directed thrombolysis monotherapy (catheter-directed thrombolysis group, n = 44) were included. The primary endpoints were the clinical efficacy rate of thrombolysis, primary patency, and the incidence of post-thrombotic syndrome (at 12 months diagnosed according to the original Villalta score criteria. Secondary endpoints were the total urokinase dose, the thrombolysis time, the detumescence rate and complications. Results The percentage of successful thrombolysis for percutaneous mechanical thrombectomy group was higher than that for catheter-directed thrombolysis group ( P = 0.045). At the 12-month follow-up, there was no difference in the primary patency ( P > 0.05) or the incidence of post-thrombotic syndrome ( P = 0.36). Percutaneous mechanical thrombectomy group had significant advantages in reducing urokinase doses and thrombolysis times compared with catheter-directed thrombolysis group for patients with thrombus clearance levels II and III ( P < 0.05). Conclusion Catheter-directed thrombolysis combined with percutaneous mechanical thrombectomy performs better in removing vein thrombi, reducing urokinase doses, and shortening thrombolysis times.

Clinical efficacy of ZelanteDVT™ catheter rheolytic thrombectomy in the single-session treatment of patients with subacute deep venous thrombosis

“…Furthermore, some existing studies on subacute thrombus removal reported that CDT is needed to achieve a better effect for thrombus removal. 14,15 However, the protracted CDT treatment would necessitate a longer hospital stay as well as an increased dose of thrombolytic drugs, both of which increase the risk of bleeding and catheter-related infection. Therefore, it is of tremendous clinical significance to explore more secure and effective treatments for subacute DVT.…”

“…3 To date, only a few retrospective studies have investigated the effectiveness of the AngioJet rheolytic thrombectomy device for subacute DVT treatment. 14,15 However, these studies employed the first-generation Solent™ AngioJet catheter (Boston Scientific, Natick, MA, USA) and prolonged CDT was required without exception. Since the launch of the latest generation of ZelanteDVT™ AngioJet catheter (Boston Scientific, Natick, MA, USA) specially designed for venous thrombectomy, there has been no report about its application in subacute DVT.…”

Single-Session Percutaneous Mechanical Thrombectomy for Acute and Subacute Deep Vein Thrombosis: Clinical Outcomes and Predictive Factors of Recurrence

“…The length of post-procedure hospital stay was defined as the number of days from PMT to hospital discharge. Upon followup imaging after discharge, recurrence was defined as thrombosis of a new venous segment or a previously involved segment that showed symptomatic and imaging improvement [5].…”

“…The most optimal indications for endovascular treatment include acute iliofemoral DVT in ambulatory patients with low bleeding risk and long-life expectancy [4]. Patients with highly symptomatic subacute DVT may also benefit from endovascular treatment [5]. Several previous studies have reported that even in subacute patients, a significant portion of thrombus could be successfully removed through PMT [6,7].…”

SECCION V. Manejo del paciente con infección por SARS-CoV-2/COVID-19

“…La Trombólisis selectiva con catéter en enfermedad vascular tromboembólica es una terapia dirigida con imagen cineangiográfica, en la cual un agente fibrinolítico es administrado directamente dentro de un trombo a través de un catéter de infusión introducido dentro del mismo 123,127,128 .…”