Clinical Studies
Percutaneous AngioJet Thrombectomy in the Management of Extensive Deep Venous Thrombosis

https://doi.org/10.1016/S1051-0443(07)61823-5Get rights and content

PURPOSE

This study was undertaken to evaluate the efficacy of a percutaneous mechanical thrombectomy (PMT) device for rapid thrombus removal following deep venous thrombosis (DVT).

MATERIALS AND METHODS

Over a 37-month period, 17 patients (14 women; mean age, 41 y620) with extensive DVT were treated with initial attempts at PMT with use of the AngioJet rheolytic thrombectomy device. Sites of venous thrombosis included lower extremities in 14 patients and upper extremity and brachiocephalic veins in three. The etiology for venous thrombosis was malignancy in seven, idiopathic etiology in three, May-Thurner syndrome and immobilization in three each, and oral contraceptive use and hypercoagulable disorder in one each. The primary endpoint was venographic evidence of thrombus extraction. Perioperative complications, mortality, and recurrencefree survival were also evaluated.

RESULTS

After PMT, four of 17 patients (24%) had venographic evidence of>90% thrombus removal, six of 17 (35%) had 50%–90% thrombus removal, and seven of 17 (41%) had <50% thrombus extraction. Adjunctive thrombolytic therapy was used in nine of 13 patients with <90% thrombus extraction by PMT; six patients (35%) had contraindications to pharmacologic thrombolytic therapy. An underlying lesion responsible for the occlusion was uncovered in 10 patients (59%). Significant improvement in clinical symptoms was seen in 14 of 17 patients (82%). No complications were noted directly relating to the use of the AngioJet thrombectomy catheter. None of the patients were lost to follow-up during a mean of 8.9 months ± 5.3 (range, 2–21 months). At 4 and 11 months, recurrence-free survival rates were 81.6% and 51.8%, respectively.

CONCLUSION

PMT with adjunctive thrombolytic therapy is a minimally invasive, low-risk therapeutic option in patients with extensive DVT, associated with clinical benefits including thrombus removal, patency, and relief of symptoms.

Section snippets

MATERIALS AND METHODS

Patients were identified from a computer registry maintained by the Department of Vascular Surgery at our institution. We retrospectively reviewed the medical records of all patients who underwent PMT for extensive DVT over a period of 37 months. Patient demographics, risk factors for DVT, periprocedural complications, and mortality were tabulated. The initial diagnosis was made by complete duplex US in all patients with extremity DVT and by MR imaging or CT in patients with intracavitary

RESULTS

Only two patients had objective evidence of earlier DVT. Risk factors for DVT are shown in the Table. There was no statistically significant association among these results and the outcome of PMT. However, because of the small sample size, there is very little power in the statistical tests to detect anything but a very strong association. Success, defined as .90% clearance of thrombus (Fig 1), was achieved in only four of 17 patients (23.5%). None of these patients subsequently received lytic

DISCUSSION

The goals of therapy in patients with DVT include prevention of pulmonary embolism, restoration of unobstructed venous return, prevention of recurrent DVT, and preservation of venous valve function. Numerous therapeutic options are currently available but not one has been proved to be superior to the other. These modalities include systemic anticoagulation, catheter-directed thrombolysis, surgical thrombectomy (with creation of arteriovenous fistula), and percutaneous mechanical or rheolytic

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