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Catheter-Directed Thrombectomy for Highly Symptomatic Patients with Iliofemoral Deep Venous Thrombosis not Responsive to Conservative Treatment

  • Clinical Investigation
  • Venous Interventions
  • Published:
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Abstract

Purpose

The use of pharmacomechanical thrombectomy in patients with symptomatic iliofemoral deep venous thrombosis (DVT) not responsive to conservative treatment is under-investigated until now. This prompted us to review and analyze our results (technical/clinical outcome, complications) and compare them to the current literature.

Materials and Methods

Between 2013 and 2019, 19 patients (14 women and 5 men; mean age: 41.2 years, SD: 18.2) with iliofemoral DVT and excessive pain not responsive to conservative treatment were treated with pharmacomechanical thrombectomy. Patients were followed up for 12 months. Demographics, technical success and clinical outcome data (pain score/Villalta score) were collected.

Results

Thrombectomy ± thrombolysis was successful in all cases (n = 19). No major complications were observed. Eight out of nineteen cases developed hematoma at the sheath insertion site not requiring further treatment. Seven out of nineteen cases required additional continuous lysis for complete iliofemoral clot solution. All patients received balloon angioplasty to treat post-thrombotic strictures. In 16/19 cases, stents were placed to preserve iliofemoral caliber and maintain unrestricted iliac venous outflow. Three patients (16%) required re-intervention due to re-thrombosis or in-stent stenosis after 4, 14 days and 4 months, respectively. Symptoms could be improved temporarily or indefinitely in 19 out of 19 patients. 1 year following thrombectomy mean pain score was reduced by 87%, mean Villalta score was 2.6 (SD: 4), and iliofemoral veins were patent in 15/17 patients.

Conclusion

In symptomatic patients with iliofemoral DVT, refractory to conservative treatment, catheter-directed thrombectomy enables rapid and long-lasting pain relief. High patency rates can be achieved in patients receiving PTA and venous stenting post-thrombectomy.

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References

  1. O'Donnell TF Jr, Browse NL, Burnand KG, Thomas ML. The socioeconomic effects of an iliofemoral venous thrombosis. J Surg Res. 1977;22(5):483–8.

    Article  Google Scholar 

  2. Delis KT, Bountouroglou D, Mansfield AO. Venous claudication in iliofemoral thrombosis: long-term effects on venous hemodynamics, clinical status, and quality of life. Ann Surg. 2004;239(1):118–26. https://doi.org/10.1097/01.sla.0000103067.10695.74.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sharifi M, Mehdipour M, Bay C, Smith G, Sharifi J. Endovenous therapy for deep venous thrombosis: the TORPEDO trial. Catheter Cardiovasc Interv Off J Soc Cardiac Angiogr Interv. 2010;76(3):316–25. https://doi.org/10.1002/ccd.22638.

    Article  Google Scholar 

  4. Akesson H, Brudin L, Dahlstrom JA, Eklof B, Ohlin P, Plate G. Venous function assessed during a 5 year period after acute ilio-femoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg. 1990;4(1):43–8.

    Article  CAS  Google Scholar 

  5. Markel A, Manzo RA, Bergelin RO, Strandness DE Jr. Valvular reflux after deep vein thrombosis: incidence and time of occurrence. J Vasc Surg. 1992;15(2):377–82 (discussion 383–374).

    Article  CAS  Google Scholar 

  6. Vedantham S, Goldhaber SZ, Julian JA, Kahn SR, Jaff MR, Cohen DJ, Magnuson E, Razavi MK, Comerota AJ, Gornik HL, Murphy TP, Lewis L, Duncan JR, Nieters P, Derfler MC, Filion M, Gu CS, Kee S, Schneider J, Saad N, Blinder M, Moll S, Sacks D, Lin J, Rundback J, Garcia M, Razdan R, VanderWoude E, Marques V, Kearon C, Investigators AT. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med. 2017;377(23):2240–52. https://doi.org/10.1056/NEJMoa1615066.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lu T, Loh TM, El-Sayed HF, Davies MG. Single-center retrospective review of ultrasound-accelerated versus traditional catheter-directed thrombolysis for acute lower extremity deep venous thrombosis. Vascular. 2017;25(5):525–32. https://doi.org/10.1177/1708538117702061.

    Article  PubMed  Google Scholar 

  8. Shi HJ, Huang YH, Shen T, Xu Q. Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis in the treatment of symptomatic lower extremity deep venous thrombosis. Eur J Radiol. 2009;71(2):350–5. https://doi.org/10.1016/j.ejrad.2008.04.015.

    Article  PubMed  Google Scholar 

  9. Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology. 1999;211(1):39–49. https://doi.org/10.1148/radiology.211.1.r99ap4739.

    Article  CAS  PubMed  Google Scholar 

  10. Enden T, Haig Y, Klow NE, Slagsvold CE, Sandvik L, Ghanima W, Hafsahl G, Holme PA, Holmen LO, Njaastad AM, Sandbaek G, Sandset PM, CaVen TSG. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet. 2012;379(9810):31–8. https://doi.org/10.1016/S0140-6736(11)61753-4.

    Article  PubMed  Google Scholar 

  11. Dopheide JF, Sebastian T, Engelberger RP, Haine A, Kucher N. Early clinical outcomes of a novel rheolytic directional thrombectomy technique for patients with iliofemoral deep vein thrombosis. VASA Zeitschrift fur Gefasskrankheiten. 2018;47(1):56–62. https://doi.org/10.1024/0301-1526/a000666.

    Article  PubMed  Google Scholar 

  12. Comerota AJ, Kearon C, Gu CS, Julian JA, Goldhaber SZ, Kahn SR, Jaff MR, Razavi MK, Kindzelski AL, Bashir R, Patel P, Sharafuddin M, Sichlau MJ, Saad WE, Assi Z, Hofmann LV, Kennedy M, Vedantham S, Investigators AT. Endovascular thrombus removal for acute iliofemoral deep vein thrombosis. Circulation. 2019;139(9):1162–73. https://doi.org/10.1161/CIRCULATIONAHA.118.037425.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Garcia MJ, Lookstein R, Malhotra R, Amin A, Blitz LR, Leung DA, Simoni EJ, Soukas PA. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: final report of the prospective multicenter PEARL (peripheral use of AngioJet rheolytic thrombectomy with a variety of catheter lengths) registry. J Vasc Interv Radiol. 2015;26(6):777–85. https://doi.org/10.1016/j.jvir.2015.01.036.

    Article  PubMed  Google Scholar 

  14. Mazzolai L, Aboyans V, Ageno W, Agnelli G, Alatri A, Bauersachs R, Brekelmans MPA, Buller HR, Elias A, Farge D, Konstantinides S, Palareti G, Prandoni P, Righini M, Torbicki A, Vlachopoulos C, Brodmann M. Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European society of cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function. Eur Heart J. 2018;39(47):4208–18. https://doi.org/10.1093/eurheartj/ehx003.

    Article  CAS  PubMed  Google Scholar 

  15. Vedantham S, Millward SF, Cardella JF, Hofmann LV, Razavi MK, Grassi CJ, Sacks D, Kinney TB. Society of interventional radiology position statement: treatment of acute iliofemoral deep vein thrombosis with use of adjunctive catheter-directed intrathrombus thrombolysis. J Vasc Interv Radiol. 2009;20(7 Suppl):S332–5. https://doi.org/10.1016/j.jvir.2009.04.017.

    Article  PubMed  Google Scholar 

  16. Vedantham S, Sista AK, Klein SJ, Nayak L, Razavi MK, Kalva SP, Saad WE, Dariushnia SR, Caplin DM, Chao CP, Ganguli S, Walker TG, Nikolic B, Society of Interventional R, Cardiovascular, Interventional Radiological Society of Europe Standards of Practice C. Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol. 2014;25(9):1317–25. https://doi.org/10.1016/j.jvir.2014.04.019.

    Article  PubMed  Google Scholar 

  17. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14(9 Pt 2):S199–202. https://doi.org/10.1097/01.rvi.0000094584.83406.3e.

    Article  PubMed  Google Scholar 

  18. Villalta S, Bagatella P, Piccioli A, Lensing AW, Prins MH, Prandoni P. Assessment of validity and reproducibility of a clinical scale for the post-thrombotic syndrome (abstract). Haemostasis. 1994;24:158a.

    Google Scholar 

  19. Pouncey AL, Silickas J, Gwozdz AM, Saha P, Black SA. Use of AngioJet pharmacomechanical thrombectomy during the treatment of iliofemoral deep vein thrombosis, reduces overall dose and exposure to lytic therapy. Eur J Vasc Endovasc Surg. 2018;56(6):e27–8. https://doi.org/10.1016/j.ejvs.2018.08.016.

    Article  Google Scholar 

  20. Comerota AJ, Grewal N, Martinez JT, Chen JT, Disalle R, Andrews L, Sepanski D, Assi Z. Postthrombotic morbidity correlates with residual thrombus following catheter-directed thrombolysis for iliofemoral deep vein thrombosis. J Vasc Surg. 2012;55(3):768–73. https://doi.org/10.1016/j.jvs.2011.10.032.

    Article  PubMed  Google Scholar 

  21. Fleck D, Albadawi H, Shamoun F, Knuttinen G, Naidu S, Oklu R. Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations. Cardiovasc Diagn Ther. 2017;7(Suppl 3):S228–37. https://doi.org/10.21037/cdt.2017.09.15.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Engelberger RP, Fahrni J, Willenberg T, Baumann F, Spirk D, Diehm N, Do DD, Baumgartner I, Kucher N. Fixed low-dose ultrasound-assisted catheter-directed thrombolysis followed by routine stenting of residual stenosis for acute ilio-femoral deep-vein thrombosis. Thromb Haemost. 2014;111(6):1153–60. https://doi.org/10.1160/TH13-11-0932.

    Article  CAS  PubMed  Google Scholar 

  23. Douketis JD, Crowther MA, Foster GA, Ginsberg JS. Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis? Am J Med. 2001;110(7):515–9.

    Article  CAS  Google Scholar 

  24. Kahn SR, Shrier I, Julian JA, Ducruet T, Arsenault L, Miron MJ, Roussin A, Desmarais S, Joyal F, Kassis J, Solymoss S, Desjardins L, Lamping DL, Johri M, Ginsberg JS. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med. 2008;149(10):698–707.

    Article  Google Scholar 

  25. O’Sullivan GJ, de Graaf R, Black SA. Just how attractive is the ATTRACT trial? Cardiovasc Interv Radiol. 2018;41(9):1313–7. https://doi.org/10.1007/s00270-018-2016-y.

    Article  Google Scholar 

  26. Kahn SR, Shbaklo H, Lamping DL, Holcroft CA, Shrier I, Miron MJ, Roussin A, Desmarais S, Joyal F, Kassis J, Solymoss S, Desjardins L, Johri M, Ginsberg JS. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost JTH. 2008;6(7):1105–12. https://doi.org/10.1111/j.1538-7836.2008.03002.x.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany

    Daniel Kuetting, Julian Luetkens, Karsten Wolter, Anton Faron & Daniel Thomas

  2. Vascular Surgery, University of Bonn, Bonn, Germany

    Alexander Kania

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  1. Daniel Kuetting
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Kuetting, D., Luetkens, J., Wolter, K. et al. Catheter-Directed Thrombectomy for Highly Symptomatic Patients with Iliofemoral Deep Venous Thrombosis not Responsive to Conservative Treatment. Cardiovasc Intervent Radiol 43, 556–564 (2020). https://doi.org/10.1007/s00270-020-02415-7

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