ABSTRACT
Adam c. Reichard, MD
Senior Vascular Surgery Fellow
Trihealth
Cincinnati, Ohio, United States
A retrospective review was performed of all consecutive patients undergoing endovascular intervention for lower extremity proximal deep venous thrombosis (DVT) from 2016-2022. During the study period, five different devices were used and divided into two groups. Group 1 consisted of rheolytic or medium bore mechanical thrombectomy with or without adjunctive thrombolysis (Boston Scientific Corp. Angiojet, Penumbra CAT 6 or 8). Group 2 consisted of large bore aspiration or mechanical thrombectomy with or without adjunctive thrombolysis (Penumbra CAT 12, Inari ClotTriever). Procedural success, complications, long term results and trends in practice patterns were evaluated. Abdominal and lower extremity venous duplex ultrasounds were used to assess for primary patency of the iliofemoral venous segment following endovascular intervention. The Primary endpoint was single-session therapy defined as removal of greater than 70% of thrombus during the index procedure without a need for prolonged thrombolytic infusion. The secondary endpoints consisted of the need for adjunctive thrombolysis and long term patency. Statistical analysis was performed using a Fischer’s exact test. A p-value of less than 0.05 was considered statistically significant.
Results: A total of 64 patients were included in this study. The majority of patients were female (39/64). Group 1 had 25 patients and Group 2 had 39 patients. Group 1 achieved single session therapy in 4/25 patients (16%) whereas Group 2 achieved single session therapy in 36/39 patients (92.3%). This was statistically significant (p-value < 0.001) recognizing the value in the new large bore venous technologies. Group 1 had 21/25 (84%) patients that required thrombolytics infusions as opposed to 3/39 (7.7%) for Group 2. This was also statistically significant (p-value < 0.001) confirming the efficacy and safety of the newer large bore thrombectomy devices. Finally, there was no statistically significant difference between Group 1 (16/25, 64%) and Group 2 (29/36, 80.5%) regarding long term patency of the iliofemoral venous segment following intervention (p-value=0.192). (3 patients in Group 2 did not have follow-up imaging)
Conclusions: Lower extremity proximal deep venous thrombosis continues to be a major health care problem throughout the world with significant morbidity and mortality. Fortunately, there are several endovascular therapies available for safe thrombus removal. This review confirms the safety and efficacy of the various devices. The data suggests the newer large bore thrombectomy devices are efficacious and essentially eliminate the need for adjunctive catheter directed thrombolytic therapy in most patients.