Percutaneous Thrombectomy Useful for Deep Venous Thrombosis

Percutaneous mechanical thrombectomy is a safe and effective treatment for deep venous thrombosis (DVT) in both the upper and lower extremities, according to a new study.

Researchers of the University of Texas Southwestern Medical Center (Dallas, USA) described the outcomes of 30 patients who were treated with percutaneous mechanical thrombectomy at their center between October 2002 and December 2005. The devices used included the Trellis-8 infusion system, which breaks down clot with a spinning wire, and the Angiojet, which macerates the clot with high-velocity bursts of saline. Both devices also allow for infusion of a thrombolytic agent. The DVT site was iliofemoral in 14 patients, iliofemoropopliteal in six, femoropopliteal in five, and subclavian vein in five. The average patient age was 50.9 years, and 10 patients had a hypercoagulable state.

All of the procedures were technically successful in crossing the DVT, and in 24 patients, percutaneous mechanical thrombectomy was performed in a single setting. The average procedure time was 145 minutes and the average thrombolytic doses were 6.2 and 10 mg of tenecteplase with the Trellis-8 and Angiojet devices, respectively. All but two of the patients required an adjunctive procedure: either angioplasty alone or in combination with stent placement. Moreover, recoverable inferior vena cava filters were placed in 21 patients, and retrieved within four weeks.

During a mean follow-up period of 6.2 months, venous patency was apparent in 27 (90%); patients and lower extremity valvular function was observed in 22 (88%) of the 25 treated lower limbs. The findings were published in the June 2007 issue of the journal Archives of Surgery.

"Percutaneous mechanical thrombectomy is effective in the treatment of acute DVT in the upper and lower extremity to restore venous patency,” concluded lead author Dr. Frank R. Arko and colleagues of the division of vascular and endovascular surgery. "In the lower extremity, valvular function is maintained acutely.”


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University of Texas Southwestern Medical Center