Single-Session Thrombectomy without Thrombolysis for Iliofemoral Deep Vein Thrombosis: A Single-Center Experience of ClotTriever with Evaluation of Predictors for Reocclusion

Abstract

Objective The aim of this study was to determine the effectiveness of a mechanical thrombectomy device in treating iliofemoral deep vein thrombosis (DVT) without thrombolysis and factors associated with post-thrombectomy occlusion. Methods A single-institution retrospective study of consecutive patients who underwent mechanical thrombectomy for iliofemoral DVT using the Inari ClotTriever device was performed from August 2019 to July 2022 without thrombolysis or aspiration. Pre- and post-thrombectomy modified Marder score, symptomatic relief, and other baseline characteristics were evaluated. Occlusion rate was evaluated by clinical symptoms and imaging studies during follow-up. Occlusion-free survival (OFS) was calculated. Factors associated with OFS were evaluated with log-rank tests and cox-proportional hazard ratio model. Procedure-related complications were reported. Results Among 32 included patients and 45 limbs, the mean Marder score decreased from 17.5 ± 8.1 to 0.13 ± 0.89 after thrombectomy. Stenting was needed in 13 patients (40.6%). No procedure-related major complication was observed postprocedurally. At initial follow-up, symptomatic improvement and occlusion-free patency were achieved in 80.0 and 72.2%, respectively. Poor venous inflow on post-thrombectomy venogram (p < 0.05) was associated with early occlusion. Suboptimal use of post-thrombectomy anticoagulation (n = 7) was the only independent predictor of clinical and radiological OFS (p = 0.042). Conclusion Mechanical thrombectomy with ClotTriever is safe and effective in the treatment of acute and/or subacute iliofemoral DVT and can mitigate the need for thrombolytic therapy. Poor venous inflow on post-thrombectomy venogram and suboptimal use of anticoagulation were associated with early reocclusion.