Comparing Incidence of Recurrent Iliofemoral Deep Venous Thrombosis Following ClotTriever Mechanical Thrombectomy and Thrombolysis: A Multicenter Retrospective Review

Sunday, March 5, 2023

4:21 PM – 4:30 PM

Location: Phoenix Convention Center, 221C

Presenting Author(s)

Alexey Y. Goloubev, MD (he/him/his)

Resident Physician
University of South Florida Morsani College of Medicine, USF Health Department of Radiology

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

RK

Richard Kang, MS

Medical Student
University of South Florida Morsani College of Medicine
ZB

Zak Boggs, MD

Resident Physician
University of South Florida
KM

Kamal Massis, MD

Attending Physician
Florida Interventional Specialists/University of South Florida
CD

Clifford Davis, MD

Associate Professor
Division of Vascular and Interventional Radiology, Morsani College of Medicine, Tampa General Hospital, University of South Florida
GH

Glenn Hoots, MD

Attending
Tampa General Hospital
BZ

Bruce Zweibel, MD

Professor, Attending Physician
University of South Florida Morsani College of Medicine, USF Health Department of Radiology, Tampa General Hospital, Florida Interventional Specialists
VG

Vaiva Gustainyte, DO

Assistant Professor of Oncologic Sciences; Assistant Member of Interventional Radiology
H. Lee Moffitt Cancer Center
JS

Jamil Shaikh, MD

Assistant Professor
Division of Vascular and Interventional Radiology, Morsani College of Medicine, Tampa General Hospital, University of South Florida

Disclosure(s):

Alexey Y. Goloubev, MD: No financial relationships to disclose

Purpose:

Deep venous thrombosis (DVT) is a common disease associated with significant morbidity and mortality. Percutaneous thrombolysis & thrombectomy of iliofemoral DVT has been reported to lead to improved venous valve function, and quality of life when compared to anticoagulation alone. Recently, introduction of newer thrombectomy devices highlighting lytic-free removal of thrombus have gained popularity. While allowing for relatively rapid and successful thrombectomy with decreased procedure time, the long-term sequela of these devices have yet to be demonstrated.

Materials and Methods:

A multi-center, retrospective review of all iliofemoral DVT interventions between June 2010-June 2022 was performed comparing patients who underwent mechanical thrombectomy (MT) utilizing the INARI CloTriever with an age-matched cohort of patients who underwent lysis-based interventions. Patient comorbidities, procedure details, periprocedural anticoagulation regimen, and complications were compared. Complications were categorized per SIR adverse event classification. Rate of recurrent and residual DVT was considered the primary endpoint at 90 days.

Results:

A total of 65 patients underwent iliofemoral DVT interventions (36 MT, average age 57.1 years, range 21-87). No significant difference in periprocedural complication rates or anticoagulation status was noted between the two groups (p< 0.05). MT was associated with reduced total intraprocedural times, contrast use and radiation dose (p< 0.05). Statistically significant increased risk of DVT recurrence was seen after MT in the setting of acute DVT when compared to lysis (58% vs 15%, p< 0.001). Risk of recurrence in patients with subacute-chronic DVT intervention was lower with MT however this was not found to be significant (24% vs 36%, p= 0.46).

Conclusion:

Utilization of INARI Clotriever in acute DVT is associated with a significantly increased risk of DVT recurrence within 90 days compared to lysis. To minimize adverse events, evaluation of thrombus chronicity should be meticulously performed prior to mechanical thrombectomy.