Aggressive percutaneous mechanical thrombectomy of deep venous thrombosis - Early clinical results

Objective: To evaluate percutaneous mechanical thrombectomy for deep venous thrombosis (DVT). Design: A retrospective analysis. Setting: Tertiary academic medical center. Patients: Thirty patients with DVT who underwent percutaneous mechanical thrombectomy. Interventions: Percutaneous mechanical thrombectomy of upper or lower extremity DVT. Main Outcome Measures: Thrombus removal, patency, and valvular function. Venography and intravascular ultrasonography assessed periprocedural lysis. Duplex ultrasonography assessed patency and valvular function before and after the procedure. Results: Fourteen patients had iliofemoral, 6 had iliofemoropopliteal, 5 had femoropopliteal, and 5 had subclavian vein thromboses. Mean age was 50.9 years (range, 15-78 years); 10 patients (33%) had a documented hypercoagulable state. There was 100% technical success in crossing the DVT, with treatment performed in a single setting in 24 patients (80%). Mean +/- SD procedural time was 1.45 +/- 35 minutes; range, 55-210 minutes. Mean thrombolytic dose was 6.2 mg of tenecteplase with the Trellis-8 and 10 mg with the AngioJet. Adjunctive procedures were required in 28 patients (percutaneous transluminal angioplasty and stent placement in 17 and percutaneous transluminal angioplasty alone in 11). Recoverable inferior vena cava filters were placed in 21 patients and retrieved within 4 weeks. There were no clinically significant periprocedural pulmonary emboli; however, 5 patients (17%) had evidence of pulmonary embolism on computed tomographic angiography (all in patients without inferior vena cava filters). Venous patency was maintained in 27 patients (90%) and lower extremity valvular function was maintained in 22 (88%) of 25 treated lower limbs, with a mean follow-up of 6.2 months (range, 3-24 months). Conclusions: Percutaneous mechanical thrombectomy is effective in the treatment of acute DVT in the upper and lower extremity to restore venous patency. In the lower extremity, valvular function is maintained acutely. Continued surveillance and follow-up will be necessary to determine whether valvular function is maintained long-term.