title: Use of percutaneous aspiration thrombectomy vs. anticoagulation therapy to treat acute iliofemoral venous thrombosis: 1-year follow-up results of a randomised, clinical trial.
abstract: OBJECTIVE
  The purpose of this study was to compare the efficacy of percutaneous aspiration thrombectomy (PAT) followed by standard anticoagulant therapy, with anticoagulation therapy alone, for the treatment of acute proximal lower extremity deep vein thrombosis.
  
  
  METHODS
  In this randomised, prospective study, 42 patients with acute proximal iliofemoral deep vein thrombosis documented via Doppler ultrasound examination, were separated into an interventional treatment group (16 males, 5 females, average age 51 years) and a medical treatment group (13 males, 8 females, average age 59 years). In the interventional group, PAT with large-lumen 9-F diameter catheterisation was applied, after initiation of standard anticoagulant therapy. Balloon angioplasty (n 19) and stent implementation (n: 14) were used to treat patients with residual stenosis (>50 %) after PAT. Prophylactic IVC filters were placed in two patients. The thrombus clearance status of the venous system was evaluated by venography. In both the medical and interventional groups, venous patency rates and clinical symptom scores were evaluated at months 1, 3, and 12 after treatment.
  
  
  RESULTS
  Deep venous systems became totally cleared of thrombi in 12 patients treated with PAT. The venous patency rates in month 12 were 57.1 and 4.76 % in the interventional and medical treatment groups, respectively. A statistically significant improvement was observed in clinical symptom scores of the interventional group (PAT) with or without stenting (4.23 ± 0.51 before treatment; 0.81 ± 0.92 at month 12) compared with the medical treatment group (4.00 ± 0.63 before treatment; 2.43 ± 0.67 at month 12). During follow-up, four patients in the medical treatment and one in the interventional group developed pulmonary embolisms.
  
  
  CONCLUSIONS
  For treatment of acute deep vein thrombosis, PAT with or without stenting is superior to anticoagulant therapy alone in terms of both ensuring venous patency and improving clinical symptoms. PAT is a safe, inexpensive, and easily performed method of endovascular treatment with a low rate of major complications. Our present findings and literature data suggest that PAT can be used as first-line treatment in proximal deep vein thrombosis patients, especially when thrombolytic treatment is contraindicated.
authors.affiliation: Ataturk Training and Research Hospital, Department of Radiology, Division of İnterventional Radiology, Katip Celebi University, Izmir, Turkey, drvolkancakir@gmail.com.
authors.forename: Volkan
authors.initials: V
authors.lastname: Cakir
authors.forename: Aytac
authors.initials: A
authors.lastname: Gulcu
authors.forename: Emrah
authors.initials: E
authors.lastname: Akay
authors.forename: Ahmet E
authors.initials: AE
authors.lastname: Capar
authors.forename: Tugra
authors.initials: T
authors.lastname: Gencpinar
authors.forename: Banu
authors.initials: B
authors.lastname: Kucuk
authors.forename: Ozalp
authors.initials: O
authors.lastname: Karabay
authors.forename: A Yigit
authors.initials: AY
authors.lastname: Goktay
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D005268:Femoral Vein; D005500:Follow-Up Studies; D006801:Humans; D007084:Iliac Vein; D035002:Lower Extremity / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011446:Prospective Studies; D015607:Stents; D017131:Thrombectomy / Q000379:methods*; D018608:Ultrasonography, Doppler; D014654:Vascular Patency; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D000925:Anticoagulants