Lower Extremity Venous Thrombolysis with Adjunctive Mechanical Thrombectomy
Section snippets
Patients
Our institutional review board approved this retrospective investigation. A computer search of our interventional radiology database was used to identify all patients who underwent catheter-directed venous thrombolysis with adjunctive MT for lower extremity and/or inferior vena caval DVT. From August 1997 through July 2001, 20 patients were identified as having undergone 22 separate procedures in the treatment of 28 symptomatic limbs. The patients' medical records, radiology reports, and
Procedural Success and Complications
Procedural success was achieved in 23 of 28 limbs (82%) that received pharmacologic thrombolysis with adjunctive MT. One additional patient had a successful clinical result after an adjunctive surgical procedure—after successful iliac vein thrombolysis and stent placement, a limited surgical thrombectomy was used to remove residual occlusive thrombus in the common femoral vein. Fifteen patients (18 limbs) received iliac vein stents.
Thrombolytic treatment failed in four limbs. Early in our
DISCUSSION
Catheter-directed thrombolysis has proved effective in treating iliofemoral DVT, but several disadvantages of therapy have limited its widespread acceptance. First, bleeding complications have been reported to occur in 0%–25% of patients in single-center series and occurred in 11% patients in a multicenter venous registry study (1, 2, 4). Second, the prolonged infusion times (2–3 d) typically required to treat iliofemoral DVT can be difficult to tolerate for some patients, and complications may
CONCLUSIONS
In summary, our experience and literature review have led us to several conclusions: (i) the MT method we used to treat DVT is unlikely to provide adequate thrombus removal alone as judged by evaluation of venograms obtained immediately after MT; (ii) the adjunctive use of MT devices with pharmacologic thrombolysis of DVT is safe and provides procedural success comparable but not demonstrably superior to that achieved with thrombolytic agents alone; (iii) caval interruption is not routinely
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Cited by (134)
Society of Interventional Radiology Position Statement on the Endovascular Management of Acute Iliofemoral Deep Vein Thrombosis
2023, Journal of Vascular and Interventional RadiologyCitation Excerpt :Rheolytic thrombectomy with the AngioJet device has been used for DVT treatment for many years, but cases in whom fibrinolytic drug therapy was not concomitantly given constitute only a small minority of the reported experience, and outcome reporting has been variable. Published reports (29,37) in which early AngioJet models were used to treat DVT suggested a limited capacity to remove large volumes of thrombus without concomitant or subsequent fibrinolytic drug administration. Within a large prospective single-arm multicenter registry of patients with DVT who were treated with AngioJet rheolytic thrombectomy (38), thrombus removal efficacy exceeded 50% in all 13 patients who did not receive fibrinolytic drug therapy.
What are the indications and options for vascular re-perfusion in the acute phase of DVT?
2021, Revue des Maladies RespiratoiresPercutaneous Thrombectomy with the JETi8 Peripheral Thrombectomy System for the Treatment of Deep Vein Thrombosis
2020, Journal of Vascular and Interventional RadiologyAcute Extremity Venous Occlusive Disease
2020, Image-Guided Interventions: Expert Radiology Series, Third EditionMidterm outcome of pharmacomechanical catheter-directed thrombolysis combined with stenting for treatment of iliac vein compression syndrome with acute iliofemoral deep venous thrombosis
2020, Journal of Vascular Surgery: Venous and Lymphatic DisordersOne-Year Results of Iliocaval Stenting
2019, Annals of Vascular Surgery
None of the authors has identified a conflict of interest.