Venous mechanical thrombectomy for deep vein thrombosis in patients with cancer: a single-center prospective study

To evaluate safety, efficacy, and clinical outcomes following venous mechanical thrombectomy (MT) for deep venous thrombosis (DVT) in patients with cancer. This single-arm, single-center prospective study evaluated patients with cancer with symptomatic lower extremity or caval DVT treated with venous MT. The primary outcome was clinical success, which was defined as a reduction in the Villalta score by ≥2 points at 6 months. Secondary outcomes included repeat intervention rates and overall survival (OS). Technical success was defined as restoring venous flow with mild (<10%) or no residual filling defect. Twenty-five patients (median age, 63; interquartile range [IQR], 58-71) were included. All patients received anticoagulation. Contraindications to thrombolytics were present in 64% (16/25), and 15 of 25 had indwelling venous devices. Most patients had proximal clot burden, with inferior vena cava and iliac thrombus in 56% and 84%, respectively. Median Villalta scores improved significantly from 10.5 (IQR, 8-14) at baseline to 4 (IQR, 3-6.3) after procedure (Wilcoxon, P < .001) and remained improved at 1- and 6-month follow-ups (P < .001). Technical success was 100%, and clinical success was 96% (24/25), with no repeat interventions. The 30-day and 6-month OS rates were 96% and 74%, respectively. One grade 3 Common Terminology Criteria for Adverse Events complication (access site hematoma) occurred. Pathologic analysis revealed tumor thrombus in 32% (7/22) of evaluable patients. MT provides rapid and durable relief from venous thromboembolism-related symptoms, improving the quality of life in patients with cancer and DVT. The high prevalence of tumor thrombus underscores thrombectomy's versatility across thrombus types as well as the possible underdiagnosis of tumor thrombus in patients with cancer.