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Two-Year Comparative Outcomes of Four Early Clot Removal Techniques for Deep Vein Thrombosis
Ozgur Ozsoy1, Murat Ugur2, Haluk Caglar Karakaya3
1Department of Cardiovascular Surgery, University of Health Sciences, Darıca Farabi Research and Training Hospital, Kocaeli, Turkey.
Insights
This study compared endovascular thrombectomy techniques and catheter-directed thrombolysis (CDT) for acute iliofemoral deep vein thrombosis (IFDVT). No significant differences in post-thrombotic syndrome (PTS) were found, though recurrence rates varied by technique.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Acute iliofemoral deep vein thrombosis (IFDVT) poses a high risk of post-thrombotic syndrome (PTS) even with treatment adherence.
- Endovascular strategies, including catheter-directed thrombolysis (CDT) and thrombectomy, aim to mitigate PTS development.
- Comparing the long-term effectiveness of available endovascular techniques is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the long-term effectiveness of different endovascular thrombectomy techniques against catheter-directed thrombolysis (CDT) for acute IFDVT.
- To assess the incidence of post-thrombotic syndrome (PTS) at 24 months post-intervention.
- To evaluate complication rates, bleeding events, and thrombosis recurrence across various endovascular methods.
Main Methods:
- Retrospective analysis of 91 adult patients with acute IFDVT treated between 2019 and 2023.
- Stratification into four groups: CDT (n=27), AngioJet rheolytic thrombectomy (n=27), AngioJet Power Pulse thrombectomy (n=17), and Mantis rotational thrombectomy (n=20).
- Primary outcome: PTS development at 24 months (Villalta score, VCSS). Secondary outcomes: complications, bleeding, and recurrence.
Main Results:
- No significant differences in PTS development at 24 months were observed among the four endovascular groups (p=0.279).
- Recurrence rates varied significantly, with higher rates in the CDT and Mantis rotational thrombectomy groups (3.7% vs. 23.5%, p=0.004).
- All techniques demonstrated acceptable safety profiles, with low rates of major bleeding and no perioperative mortality or pulmonary embolism.
Conclusions:
- Endovascular thrombectomy techniques and CDT show comparable long-term effectiveness in preventing post-thrombotic syndrome (PTS) after acute IFDVT.
- While generally safe, the choice of technique may influence thrombosis recurrence rates.
- Further research into technique-specific outcomes is warranted to guide clinical decision-making.
Background:
Despite full adherence to treatment, patients with acute iliofemoral deep vein thrombosis (IFDVT) remain at high risk for developing postthrombotic syndrome (PTS). Consequently, endovascular strategies such as early thrombus removal and catheter-directed thrombolysis (CDT) have been developed. In this study, we compared the long-term effectiveness of endovascular thrombectomy techniques and CDT available at our institution.
Methods:
We retrospectively analyzed 91 adults with acute IFDVT who underwent endovascular interventions between 2019 and 2023. Patients were stratified into four groups (G1, G2, G3, G4): CDT (n = 27), AngioJet rheolytic (n = 27), AngioJet Power Pulse (n = 17), and Mantis rotational thrombectomy (n = 20). The primary outcome was the development of PTS at 24 months, assessed using Villalta and the venous clinical severity score. Secondary outcomes included complications, major and minor bleeding events, and recurrent thrombosis.
Results:
Among the 91 patients, the mean age was 51.2 ± 18.1 years, 51.6% were male, and the mean body mass index was 27.6 ± 3.7 kg/m2. At 24 months, PTS assessed by the Villalta score showed no significant differences among groups (P = 0.279). In G1, 51.9% had no PTS, 29.6% mild, 14.8% moderate, and 3.7% severe; in G2, 59.3% had no PTS, 29.6% mild, 3.7% moderate, and 7.4% severe; in G3, 64.7% had no PTS, 5.9% mild, 11.8% moderate, and 17.6% severe; and in G4, 70% had no PTS, 20% mild, 0% moderate, and 10% severe. Major bleeding occurred in 0-7.4% of patients, minor bleeding in 7-18.5%, and acute kidney injury in 5-35.3%, with no cases of perioperative mortality or pulmonary embolism. Recurrence was observed in G1 (3.7%) and G3 (23.5%), with a statistically significant difference between groups (P = 0.004).
Conclusion:
In conclusion, our study found no significant differences among endovascular techniques regarding PTS development. All methods were generally safe, although recurrence rates varied across techniques.
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