Single Session Percutaneous Mechanical Aspiration Thrombectomy for Symptomatic Proximal Deep Venous Thrombosis
Laurel H Hastings1, Paul E Perkowski2
1Louisiana State University Health Sciences Center, Department of Surgery, New Orleans, LA;2Division of Vascular Surgery, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
INTRODUCTION: Anticoagulation and catheter-based treatments for deep venous thrombosis (DVT) have been shown to improve quality of life, and decrease post-thrombotic syndrome (PTS) rates, however these options are not safe or cost-effective in all patients. Our aim was to evaluate the feasibility, efficacy, and safety of a novel percutaneous mechanical thrombectomy technique using aspiration in a single session for the treatment of symptomatic DVT. Recent trials, including the ATTRACT and CAVENT trials, have examined PTS rates, and have demonstrated a reduction in severity of PTS in iliofemoral deep venous thrombosis.
METHODS: Records of patients who underwent percutaneous mechanical thrombectomy for DVT using aspiration (Indigo System, Penumbra, Inc.) from February, 2016 to March, 2017 were retrospectively examined. Demographic data, patient comorbidities, ultrasound characteristics, procedural data, and recurrence rates were analyzed. Early end points were primary technical success, perioperative morbidity, and survival. Primary technical success was defined as restoration of blood flow with minimal residual thrombus (<10%) without the need for a second-session of treatment. Follow up end points were clinical success, freedom from re-intervention, and freedom from recurrence (FFR), and survival at six months.
RESULTS: Eighteen patients (twelve females, mean age 62, range 23-95) were treated with mechanical thrombectomy using the Indigo System. Sixteen patients had occlusive proximal iliofemoral DVT. Primary technical success was achieved in fifteen patients (83.33%). Three patients required adjunctive methods for successful clearance of thrombus, undergoing two sessions of treatment. Two patients had recurrence of DVT following single-session treatment, both of whom were asymptomatic at time of diagnosis (FFR 88.89%). All patients were maintained on anticoagulation following treatment. There was one death during the follow up period, unrelated to index procedure.
CONCLUSIONS: Percutaneous mechanical thrombectomy of the proximal lower extremity in a single session using aspiration is safe and effective in the treatment of symptomatic deep venous thrombosis and has high technical success and low recurrence rates.
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