Use of Percutaneous Aspiration Thrombectomy vs. Anticoagulation Therapy to Treat Acute Iliofemoral Venous Thrombosis: 1-year Follow-up Results of a Randomised, Clinical Trial

Abstract

Purpose The purpose of this study was to compare the efficacy of percutaneous aspiration thrombectomy (PAT) followed by standard anticoagulant therapy, with anticoagulation therapy alone, for the treatment of acute proximal lower extremity deep vein thrombosis. Methods In this randomised, prospective study, 42 patients with acute proximal iliofemoral deep vein thrombosis documented via Doppler ultrasound examination, were separated into an interventional treatment group (16 males, 5 females, average age 51 years) and a medical treatment group (13 males, 8 females, average age 59 years). In the interventional group, PAT with largelumen 9-F diameter catheterisation was applied, after initiation of standard anticoagulant therapy. Balloon angioplasty (n 19) and stent implementation (n: 14) were used to treat patients with residual stenosis ([50 %) after PAT. Prophylactic IVC filters were placed in two patients. The thrombus clearance status of the venous system was evaluated by venography. In both the medical and interventional groups, venous patency rates and clinical symptom scores were evaluated at months 1, 3, and 12 after treatment.Results Deep venous systems became totally cleared of thrombi in 12 patients treated with PAT. The venous patency rates in month 12 were 57.1 and 4.76 % in the interventional and medical treatment groups, respectively. A statistically significant improvement was observed in clinical symptom scores of the interventional group (PAT) with or without stenting (4.23 ± 0.51 before treatment; 0.81 ± 0.92 at month 12) compared with the medical treatment group (4.00 ± 0.63 before treatment; 2.43 ± 0.67 at month 12). During follow-up, four patients in the medical treatment and one in the interventional group developed pulmonary embolisms. Conclusions For treatment of acute deep vein thrombosis, PAT with or without stenting is superior to anticoagulant therapy alone in terms of both ensuring venous patency and improving clinical symptoms. PAT is a safe, inexpensive, and easily performed method of endovascular treatment

Pathogenesis of Thromboembolism and Endovascular Management

“…However, patient numbers are low (18) and follow-up is only short term at 6 months after procedure [70]. In 2014, Cakir et al presented findings supporting the use of percutaneous aspiration thrombectomy over AC monotherapy in a randomized clinical trial involving 42 patients [71]. The TORPEDO (Thrombus Obliteration by Rapid Percutaneous Endovenous Intervention in Deep Venous Occlusion) trial devised by Sharifi et al was a randomized controlled trial of acute symptomatic proximal DVT at a single center.…”

CD163 macrophage and erythrocyte contents in aspirated deep vein thrombus are associated with the time after onset: a pilot study

“…For treatment of acute DVT, aspiration thrombectomy with or without stenting is superior to anticoagulant therapy alone in terms of ensuring venous patency and improving clinical symptoms [9]. Technological advances have allowed evaluation the pathological changes in culprit thrombi in patients with DVT.…”

Update on early thrombus removal for iliofemoral deep vein thrombosis

“…A total of 148 patients with acute or subacute iliofemoral DVT revealed patency of 80 % at 3 years follow-up and stent rate of 67 %; additional CDT was supplied in 27 %. A RCT with 21 patients in each group with iliofemoral DVT treated with thrombus aspiration versus AC showed benefit of aspiration after 1 year according to patency and a modified Villalta score (30).…”