Safety and Efficacy of Aspiration Thrombectomy or Pharmacomechanical Thrombectomy after Catheter-Directed Thrombolysis for the Treatment of Acute Iliofemoral Deep Vein Thrombosis

Abstract

Purpose To evaluate the safety and efficacy of additional aspiration thrombectomy (AT) or pharmacomechanical thrombectomy (PMT) after catheter-directed thrombolysis (CDT) for the treatment of acute iliofemoral deep vein thrombosis (AIFDVT). Materials and Methods Between May 2017 and December 2018, 40 patients with AIFDVT were enrolled. Twenty underwent AT after CDT (CDTAT), while the remaining 20 underwent PMT using an AngioJet TM device after CDT (CDTPMT). Thrombus clearance was assessed using computed tomography venography at 1 week after the procedure, as follows grade I, ≤50%; grade II, 51% to 75%; grade III, >75%. Grade III was considered a successful outcome. Treatment outcomes (thrombus clearance, thrombolytic therapy duration, urokinase dose, major complications, residual filter thrombosis, and Villalta score) were compared between the groups. Results Successful thrombus clearance was achieved in 95% of the patients in both groups. Significant decreases in the thrombolytic therapy duration (P=0.018) and urokinase dose (P=0.014) were noted in the CDTPMT group. Major complications were not noted in both groups. Residual filter thrombi >10 mm were found in 6 filters in the CDTAT group and in 1 filter in the CDTPMT group (P=0.038). The Villalta scores at 6 months were 1.47±1.24 and 1.12±0.92 in the CDTAT and CDTPMT groups, respectively (P=0.372). Conclusion Both methods may be safe and effective management options for patients with AIFDVT. CDTPMT can reduce urokinase dosage, time and remained filter thrombus compared to CDTAT. Studies conducted in the future should compare the effects of overnight CDT followed by PMT with those of single-session PMT on patients with AIFDVT.

Percutaneous Mechanical Thrombectomy of Submassive Pulmonary Embolism and Extensive Deep Venous Thrombosis for Early Thrombus Removal

“…Therefore, PMT is an attractive treatment option since www.vsijournal.org it limits the impact of thrombolytics and can extract central and peripheral emboli quickly and easily [10,[12][13][14]. Although thrombus removal as a primary treatment for DVT was dropped from the American College of Chest Physicians guideline due to a lack of evidence of reducing post-thrombotic syndrome, the long-term results of PMT including those of the Catheter-directed Venous Thrombolysis (CaVenT) study now support PMT for patients with a high proximal DVT and low risk of bleeding, such as in this case [15].…”

“…However, caution should be exercised when preventing distal embolization in PMT, as PMT fragmentation can result in detrimental large emboli, particularly in cases of an extensive thrombus burden. In such cases, preventive IVC filter placement and CDT followed by adjunctive PMT can minimize complications and maximize treatment efficiency [ 14 ].…”