Catheter-Directed Thrombolysis Versus Pharmacomechanical Thrombectomy for Upper Extremity Deep Venous Thrombosis: A Cost-Effectiveness Analysis

Mahmoud, Osman; Vikatmaa, Pirkka; Räsänen, Jari; Peltola, Erno; Sihvo, Eero; Vikatmaa, Leena; Lappalainen, Kimmo; Venermo, Maarit

doi:10.1016/j.avsg.2018.01.104

Cited by 22 publications

(16 citation statements)

References 25 publications

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“…Our results are comparable with previous publications, although the patients in these studies all had acute DVT. 22 In addition, the clinical efficacies of lysis for the PMT group were 86.67% (26/30) and for the CDT group was 65.91% (29/44) in our study. Our results are not quite comparable to those reported by Lin et al 23 Compared with the PEARL data, the clinical efficacy of lysis of PCDT is higher than the efficacies reported in our study.…”

Section: Discussionsupporting

confidence: 52%

Comparison of catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy for subacute iliofemoral deep vein thrombosis

Zhong

Yang

et al. 2020

Phlebology

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Objective To evaluate and compare the treatment efficacy and safety between catheter-directed thrombolysis monotherapy and catheter-directed thrombolysis combined with percutaneous mechanical thrombectomy for patients with subacute iliofemoral deep vein thrombosis. Methods We conducted a retrospective analysis of a total of 74 subacute iliofemoral deep vein thrombosis patients who underwent catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy. Patients treated with catheter-directed thrombolysis combined with percutaneous mechanical thrombectomy (percutaneous mechanical thrombectomy group, n = 30) or catheter-directed thrombolysis monotherapy (catheter-directed thrombolysis group, n = 44) were included. The primary endpoints were the clinical efficacy rate of thrombolysis, primary patency, and the incidence of post-thrombotic syndrome (at 12 months diagnosed according to the original Villalta score criteria. Secondary endpoints were the total urokinase dose, the thrombolysis time, the detumescence rate and complications. Results The percentage of successful thrombolysis for percutaneous mechanical thrombectomy group was higher than that for catheter-directed thrombolysis group ( P = 0.045). At the 12-month follow-up, there was no difference in the primary patency ( P > 0.05) or the incidence of post-thrombotic syndrome ( P = 0.36). Percutaneous mechanical thrombectomy group had significant advantages in reducing urokinase doses and thrombolysis times compared with catheter-directed thrombolysis group for patients with thrombus clearance levels II and III ( P < 0.05). Conclusion Catheter-directed thrombolysis combined with percutaneous mechanical thrombectomy performs better in removing vein thrombi, reducing urokinase doses, and shortening thrombolysis times.

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Section: Discussionsupporting

confidence: 52%

Comparison of catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy for subacute iliofemoral deep vein thrombosis

Zhong

Yang

et al. 2020

Phlebology

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“…While PMT devices have been shown to decrease overall treatment time, exposure to tPA, and length of stay compared to traditional CDT or systemic thrombolytics, they also cause significant red blood cell hemolysis due to high pressure spray mechanics. 12,13,16 The PEARL AngioJet registry reported 5% of enrolled patients required dialysis related to the use of the device, though the overall incidence of AKI was not described. 17 In 2017, Escobar et al reported that 29% of patients treated with AngioJet developed AKI compared to 8% of patients managed with CDT.…”

Section: Discussionmentioning

confidence: 99%

“…11 Complications using PMT methods include major bleeding and hemolysis, which may limit their utility in certain instances, particularly in those patients with cardiac arrhythmias and hyperkalemia. 12,13 The Penumbra Indigo aspiration thrombectomy system is a device for venous and arterial thrombectomy within the peripheral and coronary vasculature. It is a one-time use device designed for aspiration of fresh arterial or venous thrombus.…”

Section: Introductionmentioning

confidence: 99%

Aspiration thrombectomy for the management of acute deep venous thrombosis in the setting of venous thoracic outlet syndrome

et al. 2019

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Objectives Venous thoracic outlet syndrome, known by the eponym Paget–Schroetter syndrome, is seen in healthy, young individuals with “effort-induced thrombosis.” Endovascular therapies, including catheter-directed thrombolysis, have been described in the acute management of the upper extremity deep venous thrombosis; however, we assessed the technical success of treating this entity using a mechanical aspiration thrombectomy system. Methods This was a multi-center retrospective review of patients with venous thoracic outlet syndrome with acute thrombosis treated with the Indigo continuous aspiration mechanical thrombectomy system. Charts from patients with venous thoracic outlet syndrome and acute deep venous thrombosis treated with this system at our institution along with three data sharing locations were reviewed for demographics, deep venous thrombosis risk factors, imaging modalities used for diagnosis, extent of axillosubclavian deep venous thrombosis, treatment details, adjunctive therapies, and complications. The primary outcome was technical success (resolution of >70% of thrombus). Results There were 16 patients (50% male) with a mean age of 33 years (range 17–69 years). Six patients had underlying venous thromboembolism risk factors including use of contraceptives ( n = 2), prior deep venous thrombosis ( n = 3), and known thrombophilia ( n = 1). Fifteen patients had complete venous occlusion, and the extent of venous involvement included subclavian ( n = 14), axillary ( n = 16), and brachial ( n = 7). The majority (81.25%) of patients were treated in a single setting, and technical success was achieved in all cases with the use of adjunctive therapies. Only three patients required additional overnight thrombolytic therapy. Conclusions The Penumbra Indigo system, often in combination with adjunctive catheter-directed thrombolysis and venoplasty, is a safe and effective device for the treatment of acute upper extremity deep venous thrombosis in the setting of Paget–Schroetter syndrome. No patients experienced central embolization or post-operative renal insufficiency. One-third of patients avoided any additional catheter-directed thrombolysis exposure, and technical success was achieved in all cases. A single bleeding complication was observed in a patient undergoing overnight adjunctive catheter-directed thrombolysis. All patients maintained patency until time of first rib resection.

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“…PCDT required shorter hospital stay and less intensive surveillance leading to lower total cost. 298 In a nonrandomised retrospective analysis of 103 patients who had 110 first rib resections, 45 subclavian veins underwent thrombolysis with or without venoplasty prior to first rib resection and were compared with 65 subclavian veins treated by pre-operative anticoagulation alone. Around 91% of veins were patent in asymptomatic patients at the 16 month follow up in each of the two groups.…”

Section: Treatmentmentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis

Kakkos

Gohel²,

Bækgaard

et al. 2021

European Journal of Vascular and Endovascular Surgery

404

323

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Catheter-Directed Thrombolysis Versus Pharmacomechanical Thrombectomy for Upper Extremity Deep Venous Thrombosis: A Cost-Effectiveness Analysis

Abstract: The clinical results of the treatment of UEDVT with CDT or PMT were similar. However, PMT required shorter hospital stay and less intensive surveillance, leading to lower total costs.

Cited by 22 publications

References 25 publications

Comparison of catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy for subacute iliofemoral deep vein thrombosis

Comparison of catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy for subacute iliofemoral deep vein thrombosis

Aspiration thrombectomy for the management of acute deep venous thrombosis in the setting of venous thoracic outlet syndrome

Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis

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