AngioJet Pharmacomechanical Thrombectomy and Catheter Directed Thrombolysis vs. Catheter Directed Thrombolysis Alone for the Treatment of Iliofemoral Deep Vein Thrombosis: A Single Centre Retrospective Cohort Study. (October 2020)

• Record Type: Journal Article
• Authors: Pouncey, Anna L.; Gwozdz, Adam M.; Johnson, Oscar W.; Silickas, Justinas; Saha, Prakash; Thulasidasan, Narayan; Karunanithy, Narayan; Cohen, Ander T.; Black, Stephen A.
• Is Part Of: European journal of vascular and endovascular surgery. Volume 60:Number 4(2020)
• Page Start: 578
• Page End: 585
• Publication Date: 2020-10
• Subjects: Acute iliofemoral deep venous thrombosis -- Catheter directed thrombolysis -- Pharmacomechanical thrombolysis -- Post thrombotic syndrome -- Deep venous thrombosis -- Thrombolysis; Blood-vessels -- Endoscopic surgery -- Periodicals; Blood-vessels -- Surgery -- Periodicals; Vascular Surgical Procedures -- Periodicals; Vascular Surgical Procedures -- methods -- Periodicals; Vaisseaux sanguins -- Chirurgie -- Périodiques; Vaisseaux sanguins -- Chirurgie endoscopique -- Périodiques; Blood-vessels -- Endoscopic surgery; Blood-vessels -- Surgery; Endoscopy; Electronic journals; Periodicals; Electronic journals; 617.413005
• DOI: 10.1016/j.ejvs.2020.05.006
• Languages: English
• ISSNs: 1078-5884

Abstract

Abstract : Objective: Percutaneous thrombus removal is used for the treatment of iliofemoral deep vein thrombosis (DVT), but the efficacy of different treatment modalities has not yet been determined. The aim of this study was to compare the outcomes of patients treated with additional AngioJet pharmacomechanical thrombectomy (PCDT) vs. catheter directed lysis (CDT) alone. Methods: A retrospective review of all patients who received thrombolysis for the treatment of symptomatic acute iliofemoral DVT between 2011 and 2017 was carried out. Outcome measures included the incidence of post-thrombotic syndrome (PTS), procedural outcomes (lytic exposure), the incidence of complications, and vessel patency. All patients were followed up for a minimum of one year. Results: A total of 151 limbs were treated, 70 limbs with PCDT and 81 limbs with CDT alone. Demographic data and prevalence of risk factors were comparable. Incidence of PTS (Villalta score at one year) showed no significant difference (22.2% PCDT vs. 24.7% CDT alone, p = .74). Use of PCDT resulted in a non-statistically significant trend for fewer bleeds ( n = 4/63 [6.3%] vs. 13/76 [17.1%]; relative risk 0.37, 95% confidence interval [CI] 0.13–1.08; p = .07), a statistically significant reduction in lysis duration (40 h [95% CI 34–46] vs. 53 h [95% CI 49–58]; p < .001) and a reduction in lytic dose (49 mg [95% CI 42–55] vs. 57 mg [95% CI 52–61]; p = .011) compared with CDT. This reduction was accentuated in 24 cases primarily treated with AngioJet PowerPulse mode (27 h, 95% CI 20–34 [ p < .001] and 42 mg, 95% CI 34–50 [ p = .009]). Incidences of complications were comparable between groups, with one death due to an intracranial haemorrhage following CDT. Although the incidence of haemoglobinuria was increased following PCDT (12/63 [19.0%] vs. 3/76 [3.9%]; p = .006), no significant difference in acute kidney injury was observed (3/63 [4.8%] vs. 1/76 [1.3%]; p = .33). No significant difference in vessel patency over two years was observed ( p = .73). Conclusion: The use of PCDT for the treatment of iliofemoral DVT was observed to provide comparable patient outcomes, comparable vessel patency, an acceptable safety profile, and reduced overall lytic dose.