The ATTRACT Trial Becomes More Attractive

Bækgaard, N; Black, Stephen

doi:10.1016/j.ejvs.2019.03.017

Cited by 2 publications

(3 citation statements)

References 15 publications

(14 reference statements)

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“…Nevertheless, there was no advantage for the additional use of pharmacomechanical catheter-directed thrombolysis compared with anticoagulation alone with respect to the prevention of PTS in a recently published study [9]. Restrictively, this could be due to the fact that patients with iliofemoral as well as femoropopliteal DVT have been included in this trial [9][10][11]. Thus, a subgroup analysis of this study shows a benefit in the reduction of severe PTS for the use of pharmacomechanical catheter-directed thrombolysis, limited to patients with an iliofemoral DVT [11].…”

Section: Introductionmentioning

confidence: 99%

Surgical thrombectomy for iliofemoral deep vein thrombosis: Patient outcomes at 8.5 years

et al. 2020

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Introduction Deep vein thrombosis (DVT) is a frequent burden and a post-thrombotic syndrome (PTS) can be a serious long-term consequence. Iliofemoral DVT should be associated with severe forms of PTS. Therefore an early thrombus removal has been recommended in specific conditions. The aim of this study was to find out both, the long-term results after surgical thrombectomy of iliofemoral DVT in respect of the development of PTS as well as the venous hemodynamics after surgery concerning venous reflux and venous obstruction. Methods Sixty-seven patients who underwent surgical thrombectomy between the years 2000 and 2014 were included in this study; iliofemoral DVT was present in 52 of these patients. 35 patients could be reinvestigated after a mean follow-up of 8.5 years. CEAP (Clinical-Etiological-Anatomical-Pathophysiological) and Villalta scores were recorded in order to describe and assess PTS. Follow-up examinations included a detailed duplex mapping. Venous hemodynamics were measured by digital photoplethysmography and venous occlusion plethysmography. Results The primary patency rate of the iliofemoral segment was 88% after 8.5 years. 48% of all patients showed reflux in deep vein segments. Mild or moderate PTS occurred in 57% of all patients. Notably, there was no patient with an active ulcer or severe PTS. The mean venous outflow volume of all patients in the treated legs was 66.1 ml/100ml/min and significantly less than in the controlled contralateral non-treated legs (p<0.05). The mean venous

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Section: Introductionmentioning

confidence: 99%

Surgical thrombectomy for iliofemoral deep vein thrombosis: Patient outcomes at 8.5 years

et al. 2020

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“…13 However, the rationale behind early thrombus removal was put into question after the results of the ATTRACT trial (Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter Directed Thrombolysis) were published, 14 which suggested that early intervention of acute DVT did not reduce PTS. 15,16 Reasons behind the discordance between the ATTRACT trial conclusions and others' experience have been extensively discussed, [10][11][12] and include: (i) the use of outdated technology; (ii) heterogeneous techniques; (iii) inclusion of both femoro-popliteal and iliofemoral DVTs; (iv) a very low stenting rate; and (v) a lack of follow-up imaging to verify the open vein hypothesis. Catheter directed thrombolysis (CDT) in the treatment of IFDVT is expensive as it requires more than one interventional session and a prolonged hospital stay to yield successful outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, the patency rates of stents used to treat underlying stenosis in acute IFDVTs are high, comparable to those for non‐thrombotic lesions and better than those for post‐thrombotic obstruction 13 . However, the rationale behind early thrombus removal was put into question after the results of the ATTRACT trial (Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter Directed Thrombolysis) were published, 14 which suggested that early intervention of acute DVT did not reduce PTS 15,16 . Reasons behind the discordance between the ATTRACT trial conclusions and others' experience have been extensively discussed, 10–12 and include: (i) the use of outdated technology; (ii) heterogeneous techniques; (iii) inclusion of both femoro‐popliteal and iliofemoral DVTs; (iv) a very low stenting rate; and (v) a lack of follow‐up imaging to verify the open vein hypothesis.…”

Section: Introductionmentioning

confidence: 99%

Pharmacomechanical thrombectomy of iliofemoral deep vein thrombosis is associated with a low incidence of post‐thrombotic syndrome and perioperative complications

Larkin,

Deen,

Amirnezami

et al. 2023

ANZ Journal of Surgery

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BackgroundIliofemoral deep venous thrombosis (IFDVT) is associated with an incidence of post‐thrombotic syndrome (PTS) of up to 50%. PTS is associated with high morbidity, impaired quality of life and a significant economic burden. The aim of the current study was to assess the impact of a single session pharmacomechanical thrombectomy (PMT), dedicated venous stents and a risk mitigation protocol on the rate of PTS.MethodsBetween 2015 and 2022, patients presenting with acute or subacute IFDVT treated with the same protocol of single session PMT, dedicated venous stents, and risk‐mitigation measures were included. Procedural success rate, complications, stent patency and incidence of PTS were determined.ResultsOf 60 patients (58 ± 19 years; 65% male), the procedural success rate was 93%, with 7% of patients experiencing complications but no long‐term sequelae or mortality. Most (n = 52; 87%) patients were stented, including 46% across the inguinal ligament. At 3 months post‐procedure, primary, assisted primary and secondary stent patency rates were 89%, 93% and 98%, respectively, with no loss of patency or re‐interventions after that. At latest follow‐up of a median 48 months (n = 32), stent patency rate was 97%, with only three patients (9%) experiencing symptoms of PTS.ConclusionSingle session PMT, dedicated venous stents and a risk‐mitigation protocol results in high success rate, excellent long‐term stent patency and low incidence of PTS without compromising safety. These results support early intervention for iliofemoral DVT.

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The ATTRACT Trial Becomes More Attractive

Cited by 2 publications

References 15 publications

Surgical thrombectomy for iliofemoral deep vein thrombosis: Patient outcomes at 8.5 years

Surgical thrombectomy for iliofemoral deep vein thrombosis: Patient outcomes at 8.5 years

Pharmacomechanical thrombectomy of iliofemoral deep vein thrombosis is associated with a low incidence of post‐thrombotic syndrome and perioperative complications

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