The results of aspiration thrombecomy in the endovascular treatment for iliofemoral deep vein thrombosis

Abstract

PurposeThe aim of this study is to evaluate the results of aspiration thrombectomy (AT) in the endovascular treatment for iliofemoral deep vein thrombosis (DVT) through the comparison of catheter directed thrombolysis (CDT) alone group and CDT with AT group.MethodsFrom November 2001 to April 2011, 100 patients received endovascular treatment with CDT alone or CDT with AT for iliofemoral DVT at Yeungnam University Medical Center. We compared procedure, clinical outcomes and complications between the two groups.ResultsThe mean age of patients was 60.48 ± 14.57 years. The patients consisted of 41 men and 59 women. CDT alone and CDT with AT were performed in 29 and 71 patients, respectively. The mean procedural time of the CDT-alone group was longer than the CDT with AT group (P < 0.001) and dose of urokinase used during the procedure significantly decreased in the CDT with AT group (P < 0.001). There were no statistically significant differences in clinical outcomes between the two groups. Cases of pulmonary embolism was not noted in each group in our series, but entrapped thrombus during procedure was noted in 6 of 37 in the CDT with AT group and 0 of 9 in the CDT-alone group among 46 patients with prophylactic inferior vena cava (IVC) filter insertion.ConclusionIn conclusion, CDT with AT is safe and effective for the treatment of an acute iliofemoral DVT. In AT treatment, prophylactic IVC filter insertion should be considered for the prevention of pulmonary embolism by floating thrombi.

Percutaneous mechanical thrombectomy in the treatment of acute iliofemoral deep vein thrombosis: a systematic review

“…The mean follow-up time was 12.3 months (range, 1-82 months). Four different categories of thrombectomy devices were used among the included studies: rheolytic devices, [6][7][8][9][10][11] aspiration devices, [12][13][14][15][16] rotational devices, [16][17][18][19][20][21] and ultrasound-enhanced thrombolysis devices. 14 They aimed to achieve transcatheter removal of thrombi via different mechanical means.…”

“…Efficacy in terms of rates of venous patency, PTS, and recurrent thrombosis is shown in Table 2. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Venous patency was measured most frequently by Duplex ultrasound (n=9) followed by computed tomographic (CT) venography (n=4) and contrast venography (n=2). Imaging modalities were not mentioned in three studies.…”

“…Seven studies reported comparative evidence about PMT versus CDT (Table 4 6,9,10,11,15,18 ). Huang et al 7 showed that PMT significantly reduced PTS at 1 year, with lower Villalta scores in the PMT group (2.1±3.0) than in the CDT group (5.1±4.1; Wilcoxon rank-sum test, P=0.03).…”

“…9 The dosage of thrombolytic infusion and average procedural time were significantly reduced in the CDT with adjunctive PMT group compared with the CDT alone group, as reported in at least four different retrospective studies. 10,11,15,18 From the economic perspective, two retrospective studies performed cost analysis, and PMT was found to be associated with 44% to 49% reduction in total hospital costs. 9,10 It was also consistent with shorter hospital and intensive care unit (ICU) stays in the PMT group (4.6±1.3 days No statistically significant differences in venous patency or symptom improvement between the two groups were reported in this series of comparative studies.…”

“…The majority of the filters were removed shortly after the procedure without major complications. Lee et al 15 reported that 6 of 37 patients had thrombus entrapment in prophylactic IVC filters in the thrombectomy group compared with 0 of 9 patients in the CDT alone group. Arko et al 8 reported that 17% of patients showed asymptomatic pulmonary embolism on CT after thrombectomy, in which all patients did not receive IVC filters.…”