Early Thrombus Removal Through Peroneal Venous Approach for Treating Acute Iliofemoral Deep Vein Thrombosis

The purpose of this study was to evaluate the safety, effectiveness, and feasibility of thrombus removal using the peroneal vein (PeV) approach in acute iliofemoral deep vein thrombosis (IFDVT).

From May 2019 to July 2020, the acute IFDVT patients who had undergone AngioJet pharmacomechanical thrombectomy and/or manual aspiration thrombectomy through PeV access were analyzed retrospectively. Clinical characteristics, operative and postoperative therapy details, and PeV access-related data were investigated. Outcome measures included thrombus removal grade, venous patency rate, and the incidence of postthrombotic syndrome (PTS). All patients were followed up for a minimum of 1 year.

A total of 42 patients were reviewed. The thrombus involved the popliteal vein in 85.7% (n = 36) of cases. The PeV access was successfully achieved in all patients through 4 puncture methods. Therein, blind puncture under fluoroscopy was used in 52.4% of patients. Postoperatively, the mean thrombolysis time was 4.8 ± 1.9 days, and the average dose of urokinase was 2.7 ± 1.0 million units. All the patients had successfully thrombus lysis, including 9.5% of grade II lysis and 90.5% of grade III lysis. Three complications occurred during the thrombolysis treatment, including 2 puncture site minor bleeding and 1 minor gingival bleeding. During the 1-year follow-up, the venous patency rate and the PTS incidence rate were 97.6% and 9.5%, respectively.

Thrombus removal of acute IFDVT through PeV access is safe, effective, and feasible, while large cohort studies are needed to confirm the superiority of PeV access.