Endovascular treatment of proximal lower extremity deep vein thrombosis – experience of a center
DOI:
https://doi.org/10.48750/acv.580Keywords:
Deep vein thrombosis, endovascular thrombectomy, post-thrombotic syndromeAbstract
INTRODUCTION: Proximal lower extremity deep vein thrombosis (DVT) occurs in 5-10/10000 patients annually. Left untreated, there's a notable risk of pulmonary embolism development and the onset of long-term limb complications linked to post-thrombotic syndrome (PTS). Traditionally, these patients were treated with conservative therapy, namely anticoagulation and compression stockings. Nowadays, new and more aggressive treatments have emerged. Endovascular therapies, such as thrombectomy devices, catheter-directed thrombolysis (CDT), percutaneous transluminal angioplasty (PTA), and stent placement, provide a highly effective treatment option with minimal patient risk of complications.METHODS: We retrospectively studied all patients with proximal lower extremity DVT who were treated with endovascular therapy in our center between the years of 2018 and 2021. We choose as primary outcomes symptoms of PTS (Villalta Score) and quality of life (VEINES-QoL/Sym questionnaire) and as secondary outcomes treatment efficacy (grade of thrombolysis), treatment safety, and primary patency.
RESULTS: A total of 20 patients were treated by endovascular treatment. The majority of these patients were women (95%); 60% of them had DVT of the left limb, and 30% had phlegmasia alba dolens. Seven patients were treated with the AngiojetTM system (35%), four with the PenumbraTM system (20%) and nine with CDT alone (45%). Two patients presented with mild PTS symptoms, and the mean VEINES-QoL/Sym questionnaire score was 84.8% +/- 13.6%. There were no cases of major bleeding or pulmonary embolism after the procedure. Two patients had small vein ruptures with no need for additional treatment. The average length of stay in a high surveillance unit for vigilance was 2.2 days. At the end of treatment, 75% of the patients had complete thrombolysis, 15% had partial thrombolysis (50–99% thrombus removal), and 10% showed minimal or no thrombolysis (< 50% thrombus removal). The primary patency rate was 88% after 12 months.
CONCLUSION: Our experience has shown that endovascular therapy for acute proximal lower extremity DVT is a safe and effective treatment associated with a very low incidence of PTS and recurrent venous thromboembolism. However, life-threatening complications such as major bleeding can occur. As such, while under treatment, close monitoring of these patients in a high surveillance unit is mandatory.
Downloads
References
Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis 2016;41:3-14.
Donbaloğlu MO, Gürkan S, Gür Ö. Do treatment methods for deep vein thrombosis have different effects on post-thrombotic syndrome and the quality of life? Vascular. 2023;20:17085381231158833.
Vedantham S, Desai KR, Weinberg I, Marston W, Winokur R, Patel S, Kolli KP, Azene E, Nelson K. Society of Interventional Radiology Position Statement on the Endovascular Management of Acute Iliofemoral Deep Vein Thrombosis. J Vasc Interv Radiol. 2023;34:284-99
Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA. Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg. 2021;61:9-82.
Ashrafi M, Ahmad SB, Antoniou SA, Khan T, Antoniou GA. Treatment Strategies for Proximal Deep Vein Thrombosis: A Network Meta-analysis of Randomised Controlled Trials. Eur J Vasc Endovasc Surg. 2022;6:323-34.
Prandoni P, Kahn SR. Post-thrombotic syndrome: prevalence, prognostication and need for progress. Br J Haematol 2009;145:286-95.
Kahn R, Shrier I, Julian JA, Ducruet T, Arsenaut L, Miron M-J, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med. 2008;149: 698-707
Saarinrn J, Kallio T, Lehto M, Hiltunen S, Sisto T. The occurrence of the post-thrombotic changes after an acute deep vein thrombosis. A prospective two-year follow-up study. J Cadiovasc Surg 2000;41:441-6.
Kumar R, Rodriguez V, Matsumoto JM, Khan SP, Weaver AL, McBane RD, et al. Health-related quality of life in children and young adults with post-thrombotic syndrome: results from a cross-sectional study. Pediatr Blood Cancer. 2014;61:546-51.
Sudheendra D, Vedantham S. Catheter-Directed Therapy Options for Iliofemoral Venous Thrombosis. Surg Clin North Am. 2018;98:255-65
Haig Y, Enden T, Grøtta O, Kløw NE, Slagsvold CE, Ghanima W, et al. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol. 2016;3:64-71.
Comerota AJ. The ATTRACT trial: rationale for early intervention for iliofemoral DVT. Perspect Vasc Surg Endovasc Ther. 2009;21:221-4
Donbaloğlu MO, Gürkan S, Gür Ö. Do treatment methods for deep vein thrombosis have different effects on post-thrombotic syndrome and the quality of life? Vascular. 2023;20:17085381231158833.
AbuRahma AF, Perkins SE, Wulu JT, Ng HK. Iliofemoral deep vein thrombosis: conventional therapy versus lysis and percutaneous transluminal angioplasty and stenting. Ann Surg. 2001;233:752-60
Elsharawy M, Elzayat E. Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis. A randomised clinical trial. Eur J Vasc Endovasc Surg. 2002;24:209-14
Enden T, Haig Y, Kløw NE, Slagsvold CE, Sandvik L, Ghanima W, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet. 2012;7;379:31-8.
Kearon C, Gu CS, Julian JA, Goldhaber SZ, Comerota AJ, Gornik HL, et al Pharmacomechanical catheter-directed thrombolysis in acute femoralpopliteal deep vein thrombosis: analysis from a stratified randomized trial Thromb Haemost. 2019;119: 633-44
Moura RM, Goncalves GS, Navarro TP. Transcultural adaptation of VEINES/QoL-Sym questionnaire: evaluation of quality of life and symptoms in chronic venous disease. J Vasc Bras 2011;10:17-23.
Broholm R, Sillesen H, Damsgaard MT, Jørgensen M, Just S, Jensen LP, et al. Postthrombotic syndrome and quality of life in patients with iliofemoral venous thrombosis treated with catheter-directed thrombolysis. J Vasc Surg. 2011;54:18S-25S
Gong M, Fu G, Liu Z, Zhou Y, Kong J, Zhao B, et al. Rheolytic thrombectomy using an AngioJet ZelanteDVT catheter or a Solent Omni catheter for patients with proximal vein thrombosis. Thromb J. 2023;10;21:25.
Foegh P, Jensen LP, Klitfod L, Broholm R, Baekgaard N. Editor’s Choice e Factors associated with long-term outcome in 191 patients with ilio-femoral DVT treated with catheter-directed thrombolysis. Eur J Vasc Endovasc Surg 2017;53:419-24.
Engelberger RP, Stuck A, Spirk D, Willenberg T, Haine A, Periard D, et al. Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis: 1-year follow-up data of a randomized-controlled trial. J Thromb Haemost 2017;15:1351-60
Grunwald MR, Hofmann LV. Comparison of urokinase, alteplase, and reteplase for catheter-directed thrombolysis of deep venous thrombosis. J Vasc Interv Radiol 2004;15:347-52.
Garcia MJ, Lookstein R, Malhotra R, Amin A, Blitz LR, Leung DA, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: final report of the prospective multicenter PEARL (Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths) registry. J Vasc Interv Radiol 2015;26:777-85.
