title: Percutaneous manual aspiration thrombectomy followed by stenting for iliac vein compression syndrome with secondary acute isolated iliofemoral deep vein thrombosis: a prospective study of single-session endovascular protocol.
abstract: OBJECTIVE
  To evaluate the feasibility, safety, and effectiveness of single-session endovascular treatment with manual aspiration thrombectomy (MAT) as the first-line method of thrombus removal for iliac vein compression syndrome (IVCS) with secondary acute isolated iliofemoral deep vein thrombosis (DVT).
  
  
  METHODS
  This was a prospective clinical study. Twenty-six patients (19 women, 7 men, mean age 54 years) with left-sided acute iliac-common femoral DVT secondary to IVCS were enrolled. All patients presented with leg swelling or pains. Endovascular treatment, consisting of MAT, balloon angioplasty, and stent placement, was performed in the same setting. Overnight antegrade thrombolysis was performed in patients with residual thrombus after MAT. Patients were followed up by ultrasonography. The mean follow-up period was 17.8 months (12-25 months).
  
  
  RESULTS
  Single-session endovascular procedures were performed successfully in all patients. The mean procedure time was 67 minutes (ranging from 45 to 90 minutes). Complete thrombus removal, including almost 100% of removal in 24 patients and little residual thrombus (<5%) in two, was achieved after repeated MAT. Thrombolysis was used in these two patients. Complete symptomatic relief was achieved in 25 patients (96%) and partial relief in one. The hospital stay ranged from 2 to 4 days (mean 2.7 days). Recurrent thrombosis within the stent was observed in one case and recanalized with thrombolysis. The 1-year primary and secondary patency rate was 96% and 100%, respectively. No symptomatic pulmonary embolization, bleeding, and venous reflux were observed. Five patients complained about transitory low back pains during balloon angioplasty.
  
  
  CONCLUSIONS
  Single-session endovascular treatment with MAT as the first-line thrombus removal method is feasible, safe, and effective for IVCS with secondary acute isolated iliofemoral DVT. Although limited, our experience suggests that patients thought to be at high risk of bleeding may be candidates for the present single-session endovascular protocol.
authors.affiliation: Department of Interventional Radiology, Shunde First People's Hospital, Southern Medical University, Shunde, Guangdong, China.
authors.forename: Q H
authors.initials: QH
authors.lastname: Zhu
authors.affiliation: Department of Interventional Radiology, Shunde First People's Hospital, Southern Medical University, Shunde, Guangdong, China.
authors.forename: C Y
authors.initials: CY
authors.lastname: Zhou
authors.affiliation: Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Shunde, Guangdong, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Interventional Radiology, Shunde First People's Hospital, Southern Medical University, Shunde, Guangdong, China.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Interventional Radiology, Shunde First People's Hospital, Southern Medical University, Shunde, Guangdong, China.
authors.forename: H Y
authors.initials: HY
authors.lastname: Mo
authors.affiliation: Department of Interventional Radiology, Shunde First People's Hospital, Southern Medical University, Shunde, Guangdong, China.
authors.forename: M H
authors.initials: MH
authors.lastname: Luo
authors.affiliation: Department of Interventional Radiology, Shunde First People's Hospital, Southern Medical University, Shunde, Guangdong, China.
authors.forename: W
authors.initials: W
authors.lastname: Huang
authors.affiliation: Department of Interventional Radiology, Shunde First People's Hospital, Southern Medical University, Shunde, Guangdong, China. Electronic address: irist_dryu@163.com.
authors.forename: X F
authors.initials: XF
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D002681:China; D002985:Clinical Protocols; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D062108:May-Thurner Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents; D013396:Suction; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D015912:Thrombolytic Therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
keywords: Deep vein thrombosis; Endovascular treatment; Iliac vein compression syndrome; Manual aspiration thrombectomy; May–Thurner syndrome; Single session