Aspiration Thrombectomy as the Sole Treatment for Acute and Sub-acute Deep Venous Thrombosis (DVT) of the Lower Extremity: mid and long-term clinical results
Purpose: To determine the feasibility of aspiration thrombectomy as the sole treatment for acute and sub-acute deep vein thrombosis of the lower extremity by evaluating the mid and long-term clinical results of aspiration thrombectomy treatment. Patients and methods: During a five year period (2005-2010), 108 patients with acute and sub-acute DVT of the lower-extremity underwent aspiration thrombectomy with 9-10 guiding catheters, after insertion of a temporary inferior vena cava (IVC) filter. The inclusion criteria were patients with acute or sub-acute iliofemoral or femoropopliteal DVT of less than 4 weeks duration, with or without IVC extension. If post procedure venography demonstrated persistent stenosis or residual thrombosis, adjunctive therapy was performed by balloon angioplasty, or stent placement. The aspirate was filtered and the amount of aspirated blood separated from the clot was measured. Adjuvant thrombolysis with urokinase was performed when the aspirated blood was over 400 ml or when the aspiration thrombectomy was incomplete. Results: Anatomical success was achieved in 92/108 (85%) patients after aspiration thrombectomy treatment of the thrombosed veins. In 16 patients with residual thrombosis after thrombectomy (grade I to grade II lysis), additional thrombolysis was performed using urokinase. Seventy nine of 108 (73%) patients had residual venous stenoses post aspiration thrombectomy that were treated with stent placement and balloon angioplasty. There was no mortality associated with the procedure. On mid-term follow up, 61/75 patients (81.3%) had no recurrence of DVT and 14 patients (18.7%) demonstrated DVT recurrence. Fifty five patients (73.3%) were asymptomatic on mid-term follow-up and 20/75 (26.6%) had symptoms related to DVT. In the 52 patients who remained during long-term follow up, 41/52 (78.8%) had no recurrence of DVT and DVT recurrence was seen in 11/52 (21.1%). Thirty seven patients (71.1%) were asymptomatic on long-term follow-up and 15/52 (28.8%) were symptomatic. Conclusion: Aspiration thrombectomy is a safe, effective and economic treatment for acute proximal DVT. It showed similar clinical results with other treatment methods in mid and long term follow-up without any major complications.
deep vein thrombosis, thrombectomy, thrombolysis, May Thurner syndrome, catheter
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