SIR 2024
Venous Interventions
Abinaya Ramakrishnan, BA
Medical Student
David Geffen School of Medicine at UCLA
Financial relationships: Full list of relationships is listed on the CME information page.
John M. Moriarty, FSIR, MBBS (he/him/his)
Professor
UCLA
Financial relationships: Full list of relationships is listed on the CME information page.
Mona Ranade, MD
Assistant Professor
UCLA
Financial relationships: Full list of relationships is listed on the CME information page.
There is a lack of consensus as to the cause of decreased vessel patency post-thrombectomy: residual thrombus or endothelial wall damage from the procedure. The purpose of this study is to retrospectively compare clinical and post-thrombectomy outcomes between rheolytic thrombectomy and large bore mechanical thrombectomy for the treatment of acute deep venous thrombosis (DVT).
Materials and Methods:
A single-center, retrospective review of acute DVT interventions performed between January 2016 and February 2023 was performed comparing patients who underwent rheolytic thrombectomy with Angiojet ZelanteDVT (Boston Scientific) and large bore mechanical thrombectomy with ClotTriever (Inari Medical). Patient demographics, procedure details, periprocedural anticoagulation regimen, and repeat thrombectomy procedure within 120 days of the original procedure were compared.
Results:
A total of 41 patients with acute DVT were analyzed, 22 (53.7%) of which underwent rheolytic thrombectomy and 19 (46.3%) large bore mechanical thrombectomy. Patients who underwent large bore mechanical thrombectomy were significantly older (median age, 64 vs 48 years; p=0.009) and less likely to have a prior history of DVT (26% vs 68%; p=0.045). Large bore mechanical thrombectomy was significantly associated with acute DVT that extended the iliofemoral and popliteal region (63% vs 23%, p=0.009). Although no significant difference was found in intraprocedural characteristics like procedure time, estimated blood loss (EBL), and placement of a stent, fewer patients who underwent large bore mechanical thrombectomy required intraprocedural thrombolytics (21% vs 41%) or assistance with an additional thrombectomy device (0% vs 14%). Risk of requiring a repeat thrombectomy within 120 days post-procedure for acute DVT was lower with large bore mechanical thrombectomy; however, this was not found to be significant after controlling for patient risk factors (10.5% vs 18.1%, p =0.7).
Conclusion: No significant difference was found in the rate of repeat thrombectomy within 120 days of original procedure between rheolytic thrombectomy and large bore mechanical thrombectomy. More studies are needed with larger cohorts and longer term follow-up to establish a correlation to residual vascular obstruction versus endothelial damage.