Papers presented
Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis

Presented at the 58th Annual Meeting of the Southwestern Surgical Congress, Kauai, Hawaii, April 3–7, 2006
https://doi.org/10.1016/j.amjsurg.2006.08.045Get rights and content

Abstract

Background

Rheolytic mechanical thrombectomy using the AngioJet catheter (Possis Medical, Minneapolis, MN) has been shown to be effective in the treatment of deep venous thrombosis (DVT). Additional infusion of thrombolytic agents via the device creates a novel treatment strategy of pharmacomechanical thrombectomy (PMT), which further enhances thrombectomy efficacy. The purpose of the current study was to compare the treatment outcome in patients with symptomatic DVT who underwent either catheter-directed thrombolysis (CDT) or PMT intervention.

Methods

During a recent 8-year period, clinical records of all patients with symptomatic lower leg DVT undergoing catheter-directed interventions were evaluated. Patients were divided into 2 treatment groups: CDT or PMT. Comparisons were made with regards to the treatment outcome between the 2 groups.

Results

A total of 93 patients who underwent 98 catheter-directed interventions for DVT were included in the study. Among them, CDT or PMT was performed in 46 (47%) and 52 (53%) procedures, respectively. In the CDT group, complete or partial thrombus removal was accomplished in 32 (70%) and 14 (30%) cases, respectively. In the PMT cohort, complete or partial thrombus removal was accomplished in 39 (75%) and 13 (25%) cases, respectively. Venous balloon angioplasty and/or stenting in the CDT or PMT groups was necessary in 36 (78%) and 43 (82%), respectively (difference not significant [NS]). Patients in the CDT groups underwent a mean of 2.5 venograms during the hospital course, in contrast to 0.4 venograms per patient in PMT cohorts (P < .001). Immediate (<24 hours) improvement in clinical symptoms in CDT and PMT groups was achieved in 33 (72%) and 42 (81%) cases, respectively (NS). Significant reductions in the intensive care unit (ICU) and hospital lengths of stay was noted in the PMT group (0.6 and 4.6 days) when compared to the CDT group (2.4 and 8.4 days). During follow-up visits, the primary patency rates at 1 year of CDT and PMT groups were 64% and 68%, respectively (NS). Hospital cost analysis showed significant cost reduction in the PMT group compared to the CDT group (P < .01).

Conclusions

PMT with adjunctive thrombolytic therapy is an effective treatment modality in patients with significant DVT. When compared to CDT, this treatment provides similar treatment success with reduced ICU, total hospital length of stay, and hospital costs.

Section snippets

Patients and Methods

From May 1997 to December 2005, the hospital records and clinic charts of all patients who were diagnosed with symptomatic DVT and who underwent interventional therapy were analyzed. Patients who underwent PMT therapy using the AngioJet system during this time period were identified. For the purpose of comparison, these patients who received PMT therapy were compared to a cohort group who underwent CDT therapy. Data obtained included patient demographics, DVT risk factors, periprocedural data,

Results

During this study period, a total of 93 patients who underwent 98 catheter-directed interventions for DVT were included in the study. Among them, CDT or PMT was performed in 46 (47%) and 52 (53%) procedures, respectively (Table 1). Specifically, patients’ symptoms that led to the catheter-based intervention included lower extremity swelling (n = 34 in the PMT group, n = 29 in the CDT group), incapacitating pain (n = 14 in the PMT group, n = 12 in the CDT group), or phlegmasia dolen (n = 4 in

Comments

While many studies have reported the technical feasibility and satisfactory early outcomes of a variety of interventional treatment modalities of symptomatic DVT [9], [15], [16], [17], [18], the ideal treatment strategy for this condition remains a subject of debate. Our study is notable because it represents the first clinical study comparing the treatment outcomes of 2 well-described interventional strategies for severe deep venous thrombosis. In addition, our study demonstrated the

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