TY - JOUR
T1 - AngioJet Pharmacomechanical Thrombectomy and Catheter Directed Thrombolysis vs. Catheter Directed Thrombolysis Alone for the Treatment of Iliofemoral Deep Vein Thrombosis
T2 - A Single Centre Retrospective Cohort Study
AU - Pouncey, Anna L.
AU - Gwozdz, Adam M.
AU - Johnson, Oscar W.
AU - Silickas, Justinas
AU - Saha, Prakash
AU - Thulasidasan, Narayan
AU - Karunanithy, Narayan
AU - Cohen, Ander T.
AU - Black, Stephen A.
PY - 2020/10
Y1 - 2020/10
N2 - Objective: Percutaneous thrombus removal is used for the treatment of iliofemoral deep vein thrombosis (DVT), but the efficacy of different treatment modalities has not yet been determined. The aim of this study was to compare the outcomes of patients treated with additional AngioJet pharmacomechanical thrombectomy (PCDT) vs. catheter directed lysis (CDT) alone. Methods: A retrospective review of all patients who received thrombolysis for the treatment of symptomatic acute iliofemoral DVT between 2011 and 2017 was carried out. Outcome measures included the incidence of post-thrombotic syndrome (PTS), procedural outcomes (lytic exposure), the incidence of complications, and vessel patency. All patients were followed up for a minimum of one year. Results: A total of 151 limbs were treated, 70 limbs with PCDT and 81 limbs with CDT alone. Demographic data and prevalence of risk factors were comparable. Incidence of PTS (Villalta score at one year) showed no significant difference (22.2% PCDT vs. 24.7% CDT alone, p =.74). Use of PCDT resulted in a non-statistically significant trend for fewer bleeds (n = 4/63 [6.3%] vs. 13/76 [17.1%]; relative risk 0.37, 95% confidence interval [CI] 0.13–1.08; p =.07), a statistically significant reduction in lysis duration (40 h [95% CI 34–46] vs. 53 h [95% CI 49–58]; p <.001) and a reduction in lytic dose (49 mg [95% CI 42–55] vs. 57 mg [95% CI 52–61]; p =.011) compared with CDT. This reduction was accentuated in 24 cases primarily treated with AngioJet PowerPulse mode (27 h, 95% CI 20–34 [p <.001] and 42 mg, 95% CI 34–50 [p =.009]). Incidences of complications were comparable between groups, with one death due to an intracranial haemorrhage following CDT. Although the incidence of haemoglobinuria was increased following PCDT (12/63 [19.0%] vs. 3/76 [3.9%]; p =.006), no significant difference in acute kidney injury was observed (3/63 [4.8%] vs. 1/76 [1.3%]; p =.33). No significant difference in vessel patency over two years was observed (p =.73). Conclusion: The use of PCDT for the treatment of iliofemoral DVT was observed to provide comparable patient outcomes, comparable vessel patency, an acceptable safety profile, and reduced overall lytic dose.
AB - Objective: Percutaneous thrombus removal is used for the treatment of iliofemoral deep vein thrombosis (DVT), but the efficacy of different treatment modalities has not yet been determined. The aim of this study was to compare the outcomes of patients treated with additional AngioJet pharmacomechanical thrombectomy (PCDT) vs. catheter directed lysis (CDT) alone. Methods: A retrospective review of all patients who received thrombolysis for the treatment of symptomatic acute iliofemoral DVT between 2011 and 2017 was carried out. Outcome measures included the incidence of post-thrombotic syndrome (PTS), procedural outcomes (lytic exposure), the incidence of complications, and vessel patency. All patients were followed up for a minimum of one year. Results: A total of 151 limbs were treated, 70 limbs with PCDT and 81 limbs with CDT alone. Demographic data and prevalence of risk factors were comparable. Incidence of PTS (Villalta score at one year) showed no significant difference (22.2% PCDT vs. 24.7% CDT alone, p =.74). Use of PCDT resulted in a non-statistically significant trend for fewer bleeds (n = 4/63 [6.3%] vs. 13/76 [17.1%]; relative risk 0.37, 95% confidence interval [CI] 0.13–1.08; p =.07), a statistically significant reduction in lysis duration (40 h [95% CI 34–46] vs. 53 h [95% CI 49–58]; p <.001) and a reduction in lytic dose (49 mg [95% CI 42–55] vs. 57 mg [95% CI 52–61]; p =.011) compared with CDT. This reduction was accentuated in 24 cases primarily treated with AngioJet PowerPulse mode (27 h, 95% CI 20–34 [p <.001] and 42 mg, 95% CI 34–50 [p =.009]). Incidences of complications were comparable between groups, with one death due to an intracranial haemorrhage following CDT. Although the incidence of haemoglobinuria was increased following PCDT (12/63 [19.0%] vs. 3/76 [3.9%]; p =.006), no significant difference in acute kidney injury was observed (3/63 [4.8%] vs. 1/76 [1.3%]; p =.33). No significant difference in vessel patency over two years was observed (p =.73). Conclusion: The use of PCDT for the treatment of iliofemoral DVT was observed to provide comparable patient outcomes, comparable vessel patency, an acceptable safety profile, and reduced overall lytic dose.
KW - Acute iliofemoral deep venous thrombosis
KW - Catheter directed thrombolysis
KW - Deep venous thrombosis
KW - Pharmacomechanical thrombolysis
KW - Post thrombotic syndrome
KW - Thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=85087744784&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2020.05.006
DO - 10.1016/j.ejvs.2020.05.006
M3 - Article
AN - SCOPUS:85087744784
SN - 1078-5884
VL - 60
SP - 578
EP - 585
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 4
ER -
