Percutaneous AngioJet thrombectomy in the management of extensive deep venous thrombosis.
OBJECTIVE
This study was undertaken to evaluate the efficacy of a percutaneous mechanical thrombectomy (PMT) device for rapid thrombus removal following deep venous thrombosis (DVT).


METHODS
Over a 37-month period, 17 patients (14 women; mean age, 41 y +/- 20) with extensive DVT were treated with initial attempts at PMT with use of the AngioJet rheolytic thrombectomy device. Sites of venous thrombosis included lower extremities in 14 patients and upper extremity and brachiocephalic veins in three. The etiology for venous thrombosis was malignancy in seven, idiopathic etiology in three, May-Thurner syndrome and immobilization in three each, and oral contraceptive use and hypercoagulable disorder in one each. The primary endpoint was venographic evidence of thrombus extraction. Perioperative complications, mortality, and recurrence-free survival were also evaluated.


RESULTS
After PMT, four of 17 patients (24%) had venographic evidence of >90% thrombus removal, six of 17 (35%) had 50%-90% thrombus removal, and seven of 17 (41%) had <50% thrombus extraction. Adjunctive thrombolytic therapy was used in nine of 13 patients with <90% thrombus extraction by PMT; six patients (35%) had contraindications to pharmacologic thrombolytic therapy. An underlying lesion responsible for the occlusion was uncovered in 10 patients (59%). Significant improvement in clinical symptoms was seen in 14 of 17 patients (82%). No complications were noted directly relating to the use of the AngioJet thrombectomy catheter. None of the patients were lost to follow-up during a mean of 8.9 months +/- 5.3 (range, 2-21 months). At 4 and 11 months, recurrence-free survival rates were 81.6% and 51.8%, respectively.


CONCLUSIONS
PMT with adjunctive thrombolytic therapy is a minimally invasive, low-risk therapeutic option in patients with extensive DVT, associated with clinical benefits including thrombus removal, patency, and relief of symptoms.
Division of Vascular Surgery, University of New Mexico Hospital, Albuquerque 87131-5341, USA. kkasirajan@aol.com
K
K
Kasirajan
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B
Gray
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Ouriel
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011859:Radiography; D015642:Radiology, Interventional; D012008:Recurrence; D015996:Survival Rate; D017131:Thrombectomy / Q000295:instrumentation; D015912:Thrombolytic Therapy; D013997:Time Factors; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*
D000925:Anticoagulants