J Korean Surg Soc.  2013 May;84(5):292-297.

The results of aspiration thrombecomy in the endovascular treatment for iliofemoral deep vein thrombosis

• Lee JH
• Kwun WH
• Suh BY

Abstract

PURPOSE
The aim of this study is to evaluate the results of aspiration thrombectomy (AT) in the endovascular treatment for iliofemoral deep vein thrombosis (DVT) through the comparison of catheter directed thrombolysis (CDT) alone group and CDT with AT group.
METHODS
From November 2001 to April 2011, 100 patients received endovascular treatment with CDT alone or CDT with AT for iliofemoral DVT at Yeungnam University Medical Center. We compared procedure, clinical outcomes and complications between the two groups.
RESULTS
The mean age of patients was 60.48 +/- 14.57 years. The patients consisted of 41 men and 59 women. CDT alone and CDT with AT were performed in 29 and 71 patients, respectively. The mean procedural time of the CDT-alone group was longer than the CDT with AT group (P < 0.001) and dose of urokinase used during the procedure significantly decreased in the CDT with AT group (P < 0.001). There were no statistically significant differences in clinical outcomes between the two groups. Cases of pulmonary embolism was not noted in each group in our series, but entrapped thrombus during procedure was noted in 6 of 37 in the CDT with AT group and 0 of 9 in the CDT-alone group among 46 patients with prophylactic inferior vena cava (IVC) filter insertion.
CONCLUSION
In conclusion, CDT with AT is safe and effective for the treatment of an acute iliofemoral DVT. In AT treatment, prophylactic IVC filter insertion should be considered for the prevention of pulmonary embolism by floating thrombi.

Keyword

Deep vein thrombosis; Thrombolysis; Catheters; Mechanical thrombectomy; Vena cava filters

MeSH Terms

Academic Medical Centers
Catheters
Female
Humans
Male
Pulmonary Embolism
Thrombectomy
Thrombosis
Urokinase-Type Plasminogen Activator
Vena Cava Filters
Vena Cava, Inferior
Venous Thrombosis
Urokinase-Type Plasminogen Activator

Figure

• 

  Fig. 1 The patency rate of iliac vein by thrombus dissolution (P = 0.546). CDT, catheter directed thrombolysis; AT, aspiration thrombectomy.

Reference

1. White RH. The epidemiology of venous thromboembolism. Circulation. 2003. 107:23 Suppl 1. I4–I8.

2. Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P, et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med. 2004. 117:19–25.

3. Jang MJ, Bang SM, Oh D. Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost. 2011. 9:85–91.

4. Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Bergqvist D, Brecht JG, et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost. 2007. 98:756–764.

5. Nyamekye I, Merker L. Management of proximal deep vein thrombosis. Phlebology. 2012. 27:Suppl 2. 61–72.

6. Sharafuddin MJ, Sun S, Hoballah JJ, Youness FM, Sharp WJ, Roh BS. Endovascular management of venous thrombotic and occlusive diseases of the lower extremities. J Vasc Interv Radiol. 2003. 14:405–423.

7. Meissner MH, Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, et al. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2012. 55:1449–1462.

8. Okrent D, Messersmith R, Buckman J. Transcatheter fibrinolytic therapy and angioplasty for left iliofemoral venous thrombosis. J Vasc Interv Radiol. 1991. 2:195–197.

9. Palombo D, Porta C, Brustia P, Peinetti F, Udini M, Antico A, et al. Loco-regional thrombolysis in deep venous thrombosis. Phlebologie. 1993. 46:293–302.

10. Semba CP, Dake MD. Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis. Radiology. 1994. 191:487–494.

11. Bjarnason H, Kruse JR, Asinger DA, Nazarian GK, Dietz CA Jr, Caldwell MD, et al. Iliofemoral deep venous thrombosis: safety and efficacy outcome during 5 years of catheter-directed thrombolytic therapy. J Vasc Interv Radiol. 1997. 8:405–418.

12. 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. 211:39–49.

13. Cho JS, Martelli E, Mozes G, Miller VM, Gloviczki P. Effects of thrombolysis and venous thrombectomy on valvular competence, thrombogenicity, venous wall morphology, and function. J Vasc Surg. 1998. 28:787–799.

14. Enden T, Haig Y, Klow NE, Slagsvold CE, Sandvik L, Ghanima W, et al. 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. 379:31–38.

15. Murphy KD. Mechanical thrombectomy for DVT. Tech Vasc Interv Radiol. 2004. 7:79–85.

16. Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ, et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008. 133:6 Suppl. 454S–545S.

17. Sniderman KW, Bodner L, Saddekni S, Srur M, Sos TA. Percutaneous embolectomy by transcatheter aspiration. Work in progress. Radiology. 1984. 150:357–361.

18. Kwon SH, Oh JH, Seo TS, Ahn HJ, Park HC. Percutaneous aspiration thrombectomy for the treatment of acute lower extremity deep vein thrombosis: is thrombolysis needed? Clin Radiol. 2009. 64:484–490.

19. O'Sullivan GJ. The role of interventional radiology in the management of deep venous thrombosis: advanced therapy. Cardiovasc Intervent Radiol. 2011. 34:445–461.

20. Vedantham S, Vesely TM, Parti N, Darcy M, Hovsepian DM, Picus D. Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy. J Vasc Interv Radiol. 2002. 13:1001–1008.

21. Kim HS, Patra A, Paxton BE, Khan J, Streiff MB. Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis: clinical and economic outcomes. J Vasc Interv Radiol. 2006. 17:1099–1104.

22. Enden T, Klow NE, Sandvik L, Slagsvold CE, Ghanima W, Hafsahl G, et al. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on short-term patency. J Thromb Haemost. 2009. 7:1268–1275.

23. Kinney TB, Valji K, Rose SC, Yeung DD, Oglevie SB, Roberts AC, et al. Pulmonary embolism from pulse-spray pharmacomechanical thrombolysis of clotted hemodialysis grafts: urokinase versus heparinized saline. J Vasc Interv Radiol. 2000. 11:1143–1152.

24. Noguchi M, Eishi K, Sakamoto I, Nakamura S, Yamachika S, Hazama S, et al. Thrombus removal with a temporary vena caval filter in patients with acute proximal deep vein thrombosis. Heart Vessels. 2003. 18:197–201.