title: Mechanical thrombectomy with Trerotola compared with catheter-directed thrombolysis for treatment of acute iliofemoral deep vein thrombosis.
abstract: BACKGROUND
  Mechanical thrombectomy (MT) of acute deep vein thrombosis (DVT) is safe and effective in reducing thrombus burden. MT utilizing a percutaneous thrombectomy device confers a great advantage because it may reduce both the dose of the thrombolytic agent and the overall procedure time compared with a conventional catheter-directed thrombolysis (CDT). We examined the results of MT using the Trerotola device and evaluated factors affecting patient outcome.
  
  
  METHODS
  This retrospective study was performed using data from a database of patients who had undergone treatment for an acute iliofemoral DVT from January 2005 to December 2011, at 2 institutions. The patients' clinical characteristics and procedures were compared, and the outcomes of treatment with the Trerotola in the MT group were compared with those obtained with CDT.
  
  
  RESULTS
  There were a total of 98 DVTs (left 76; right 22) in 90 patients (34 men); 53 DVTs were treated with MT and 45 with CDT. There were no statistical differences in the clinical characteristics among the MT with CDT, MT only and CDT group. Inferior vena cava filters were placed in 93 DVTs (95%), and iliac vein stenting was used in 64 (65%). Symptom improvement was seen in 78% (18 limbs) of the MT group, 80% (24 limbs) of the MT with CDT group, and 71% (32 limbs) of the CDT group (P = 0.498). The procedure time was shorter in the MT with CDT group (18.2 ± 8.2 hr) or in the MT only group (2.7 ± 2.0 hr) compared with the CDT group (29.3 ± 9.4 hr; P < 0.001). Urokinase dose was lower in MT only (0 million units) or in the MT with CDT group (5.13 ± 3.72 million units) than in the CDT group (7.51 ± 4.54 million units; P < 0.001). There was no difference in complications during the procedures or in primary patency rate during the follow-up period (mean 16.0 ± 19.1 months; range: 0-78 months).
  
  
  CONCLUSIONS
  MT with the Trerotola device for acute iliofemoral DVT required shorter procedure times and lower urokinase doses than conventional CDT, while providing the same results.
authors.affiliation: Department of Surgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Keun-Myoung
authors.initials: KM
authors.lastname: Park
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: In Sung
authors.initials: IS
authors.lastname: Moon
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Ji Il
authors.initials: JI
authors.lastname: Kim
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sang-Sup
authors.initials: SS
authors.lastname: Yun
authors.affiliation: Department of Surgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Kee Chun
authors.initials: KC
authors.lastname: Hong
authors.affiliation: Department of Radiology, Inha University School of Medicine, Incheon, Korea.
authors.forename: Yong Sun
authors.initials: YS
authors.lastname: Jeon
authors.affiliation: Department of Radiology, Inha University School of Medicine, Incheon, Korea.
authors.forename: Soon Gu
authors.initials: SG
authors.lastname: Cho
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. Electronic address: vascularkim@catholic.ac.kr.
authors.forename: Jang Yong
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral; D005260:Female; D005268:Femoral Vein; D006801:Humans; D007084:Iliac Vein; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017131:Thrombectomy / Q000295:instrumentation*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000628:therapy*