Aggressive percutaneous mechanical thrombectomy of deep venous thrombosis: Early clinical results

Frank R. Arko, Charles M. Davis, Erin H. Murphy, Stephen T. Smith, Carlos H. Timaran, J. Gregory Modrall, R. James Valentine, G. Patrick Clagett

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Objective: To evaluate percutaneous mechanical thrombectomy for deep venous thrombosis (DVT). Design: A retrospective analysis. Setting: Tertiary academic medical center. Patients: Thirty patients with DVT who underwent percutaneous mechanical thrombectomy. Interventions: Percutaneous mechanical thrombectomy of upper or lower extremity DVT. Main Outcome Measures: Thrombus removal, patency, and valvular function. Venography and intravascular ultrasonography assessed periprocedural lysis. Duplex ultrasonography assessed patency and valvular function before and after the procedure. Results: Fourteen patients had iliofemoral, 6 had iliofemoropopliteal, 5 had femoropopliteal, and 5 had subclavian vein thromboses. Mean age was 50.9 years (range, 15-78 years); 10 patients (33%) had a documented hypercoagulable state. There was 100% technical success in crossing the DVT, with treatment performed in a single setting in 24 patients (80%). Mean ± SD procedural time was 145 ± 35 minutes; range, 55-210 minutes. Mean thrombolytic dose was 6.2 mg of tenecteplase with the Trellis-8 and 10 mg with the AngioJet. Adjunctive procedures were required in 28 patients (percutaneous transluminal angioplasty and stent placement in 17 and percutaneous transluminal angioplasty alone in 11). Recoverable inferior vena cava filters were placed in 21 patients and retrieved within 4 weeks. There were no clinically significant periprocedural pulmonary emboli; however, 5 patients (17%) had evidence of pulmonary embolism on computed tomographic angiography (all in patients without inferior vena cava filters). Venous patency was maintained in 27 patients (90%) and lower extremity valvular function was maintained in 22 (88%) of 25 treated lower limbs, with a mean follow-up of 6.2 months (range, 3-24 months). Conclusions: Percutaneous mechanical thrombectomy is effective in the treatment of acute DVT in the upper and lower extremity to restore venous patency. In the lower extremity, valvular function is maintained acutely. Continued surveillance and follow-up will be necessary to determine whether valvular function is maintained long-term.

Original languageEnglish (US)
Pages (from-to)513-518
Number of pages6
JournalArchives of Surgery
Volume142
Issue number6
DOIs
StatePublished - Jun 2007

Fingerprint

Thrombectomy
Venous Thrombosis
Lower Extremity
Vena Cava Filters
Angioplasty
Thrombosis
Interventional Ultrasonography
Subclavian Vein
Phlebography
Embolism
Pulmonary Embolism
Stents
Ultrasonography
Angiography
Outcome Assessment (Health Care)
Lung

ASJC Scopus subject areas

  • Surgery

Cite this

Aggressive percutaneous mechanical thrombectomy of deep venous thrombosis : Early clinical results. / Arko, Frank R.; Davis, Charles M.; Murphy, Erin H.; Smith, Stephen T.; Timaran, Carlos H.; Modrall, J. Gregory; Valentine, R. James; Clagett, G. Patrick.

In: Archives of Surgery, Vol. 142, No. 6, 06.2007, p. 513-518.

Research output: Contribution to journalArticle

Arko, Frank R. ; Davis, Charles M. ; Murphy, Erin H. ; Smith, Stephen T. ; Timaran, Carlos H. ; Modrall, J. Gregory ; Valentine, R. James ; Clagett, G. Patrick. / Aggressive percutaneous mechanical thrombectomy of deep venous thrombosis : Early clinical results. In: Archives of Surgery. 2007 ; Vol. 142, No. 6. pp. 513-518.
@article{e18cd198fb1344279c41a986ee9d3290,
title = "Aggressive percutaneous mechanical thrombectomy of deep venous thrombosis: Early clinical results",
abstract = "Objective: To evaluate percutaneous mechanical thrombectomy for deep venous thrombosis (DVT). Design: A retrospective analysis. Setting: Tertiary academic medical center. Patients: Thirty patients with DVT who underwent percutaneous mechanical thrombectomy. Interventions: Percutaneous mechanical thrombectomy of upper or lower extremity DVT. Main Outcome Measures: Thrombus removal, patency, and valvular function. Venography and intravascular ultrasonography assessed periprocedural lysis. Duplex ultrasonography assessed patency and valvular function before and after the procedure. Results: Fourteen patients had iliofemoral, 6 had iliofemoropopliteal, 5 had femoropopliteal, and 5 had subclavian vein thromboses. Mean age was 50.9 years (range, 15-78 years); 10 patients (33{\%}) had a documented hypercoagulable state. There was 100{\%} technical success in crossing the DVT, with treatment performed in a single setting in 24 patients (80{\%}). Mean ± SD procedural time was 145 ± 35 minutes; range, 55-210 minutes. Mean thrombolytic dose was 6.2 mg of tenecteplase with the Trellis-8 and 10 mg with the AngioJet. Adjunctive procedures were required in 28 patients (percutaneous transluminal angioplasty and stent placement in 17 and percutaneous transluminal angioplasty alone in 11). Recoverable inferior vena cava filters were placed in 21 patients and retrieved within 4 weeks. There were no clinically significant periprocedural pulmonary emboli; however, 5 patients (17{\%}) had evidence of pulmonary embolism on computed tomographic angiography (all in patients without inferior vena cava filters). Venous patency was maintained in 27 patients (90{\%}) and lower extremity valvular function was maintained in 22 (88{\%}) of 25 treated lower limbs, with a mean follow-up of 6.2 months (range, 3-24 months). Conclusions: Percutaneous mechanical thrombectomy is effective in the treatment of acute DVT in the upper and lower extremity to restore venous patency. In the lower extremity, valvular function is maintained acutely. Continued surveillance and follow-up will be necessary to determine whether valvular function is maintained long-term.",
author = "Arko, {Frank R.} and Davis, {Charles M.} and Murphy, {Erin H.} and Smith, {Stephen T.} and Timaran, {Carlos H.} and Modrall, {J. Gregory} and Valentine, {R. James} and Clagett, {G. Patrick}",
year = "2007",
month = "6",
doi = "10.1001/archsurg.142.6.513",
language = "English (US)",
volume = "142",
pages = "513--518",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "6",

}

TY - JOUR

T1 - Aggressive percutaneous mechanical thrombectomy of deep venous thrombosis

T2 - Early clinical results

AU - Arko, Frank R.

AU - Davis, Charles M.

AU - Murphy, Erin H.

AU - Smith, Stephen T.

AU - Timaran, Carlos H.

AU - Modrall, J. Gregory

AU - Valentine, R. James

AU - Clagett, G. Patrick

PY - 2007/6

Y1 - 2007/6

N2 - Objective: To evaluate percutaneous mechanical thrombectomy for deep venous thrombosis (DVT). Design: A retrospective analysis. Setting: Tertiary academic medical center. Patients: Thirty patients with DVT who underwent percutaneous mechanical thrombectomy. Interventions: Percutaneous mechanical thrombectomy of upper or lower extremity DVT. Main Outcome Measures: Thrombus removal, patency, and valvular function. Venography and intravascular ultrasonography assessed periprocedural lysis. Duplex ultrasonography assessed patency and valvular function before and after the procedure. Results: Fourteen patients had iliofemoral, 6 had iliofemoropopliteal, 5 had femoropopliteal, and 5 had subclavian vein thromboses. Mean age was 50.9 years (range, 15-78 years); 10 patients (33%) had a documented hypercoagulable state. There was 100% technical success in crossing the DVT, with treatment performed in a single setting in 24 patients (80%). Mean ± SD procedural time was 145 ± 35 minutes; range, 55-210 minutes. Mean thrombolytic dose was 6.2 mg of tenecteplase with the Trellis-8 and 10 mg with the AngioJet. Adjunctive procedures were required in 28 patients (percutaneous transluminal angioplasty and stent placement in 17 and percutaneous transluminal angioplasty alone in 11). Recoverable inferior vena cava filters were placed in 21 patients and retrieved within 4 weeks. There were no clinically significant periprocedural pulmonary emboli; however, 5 patients (17%) had evidence of pulmonary embolism on computed tomographic angiography (all in patients without inferior vena cava filters). Venous patency was maintained in 27 patients (90%) and lower extremity valvular function was maintained in 22 (88%) of 25 treated lower limbs, with a mean follow-up of 6.2 months (range, 3-24 months). Conclusions: Percutaneous mechanical thrombectomy is effective in the treatment of acute DVT in the upper and lower extremity to restore venous patency. In the lower extremity, valvular function is maintained acutely. Continued surveillance and follow-up will be necessary to determine whether valvular function is maintained long-term.

AB - Objective: To evaluate percutaneous mechanical thrombectomy for deep venous thrombosis (DVT). Design: A retrospective analysis. Setting: Tertiary academic medical center. Patients: Thirty patients with DVT who underwent percutaneous mechanical thrombectomy. Interventions: Percutaneous mechanical thrombectomy of upper or lower extremity DVT. Main Outcome Measures: Thrombus removal, patency, and valvular function. Venography and intravascular ultrasonography assessed periprocedural lysis. Duplex ultrasonography assessed patency and valvular function before and after the procedure. Results: Fourteen patients had iliofemoral, 6 had iliofemoropopliteal, 5 had femoropopliteal, and 5 had subclavian vein thromboses. Mean age was 50.9 years (range, 15-78 years); 10 patients (33%) had a documented hypercoagulable state. There was 100% technical success in crossing the DVT, with treatment performed in a single setting in 24 patients (80%). Mean ± SD procedural time was 145 ± 35 minutes; range, 55-210 minutes. Mean thrombolytic dose was 6.2 mg of tenecteplase with the Trellis-8 and 10 mg with the AngioJet. Adjunctive procedures were required in 28 patients (percutaneous transluminal angioplasty and stent placement in 17 and percutaneous transluminal angioplasty alone in 11). Recoverable inferior vena cava filters were placed in 21 patients and retrieved within 4 weeks. There were no clinically significant periprocedural pulmonary emboli; however, 5 patients (17%) had evidence of pulmonary embolism on computed tomographic angiography (all in patients without inferior vena cava filters). Venous patency was maintained in 27 patients (90%) and lower extremity valvular function was maintained in 22 (88%) of 25 treated lower limbs, with a mean follow-up of 6.2 months (range, 3-24 months). Conclusions: Percutaneous mechanical thrombectomy is effective in the treatment of acute DVT in the upper and lower extremity to restore venous patency. In the lower extremity, valvular function is maintained acutely. Continued surveillance and follow-up will be necessary to determine whether valvular function is maintained long-term.

UR - http://www.scopus.com/inward/record.url?scp=34250766715&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34250766715&partnerID=8YFLogxK

U2 - 10.1001/archsurg.142.6.513

DO - 10.1001/archsurg.142.6.513

M3 - Article

C2 - 17576886

AN - SCOPUS:34250766715

VL - 142

SP - 513

EP - 518

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 6

ER -