Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis

Robertson, Lindsay; McBride, Olivia; Burdess, Anne

doi:10.1002/14651858.cd011536.pub2

Cited by 25 publications

(14 citation statements)

References 21 publications

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“…no randomized clinical trials on PCDT that met inclusion criteria for the study (49). It remains unknown whether PCDT increases risk for PE in the short-term, and whether temporary IVC filter placement is indicated (29).…”

mentioning

confidence: 99%

Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations

Fleck

Albadawi

Shamoun

et al. 2017

Cardiovasc. Diagn. Ther.

100

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Deep vein thrombosis (DVT) is a major health problem worldwide. The risk of pulmonary embolism following DVT is well established, but the long-term vascular sequelae of DVT are often underappreciated, costly to manage, and can have extremely detrimental effects on quality of life. Treatment of DVT classically involves oral anticoagulation, which reduces the risk of pulmonary embolism but does not remove the clot. Anticoagulation therefore does little to prevent the venous damage and scarring that occurs following DVT, leaving the patient at risk for permanent venous insufficiency and development of post-thrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) is a minimally invasive endovascular treatment that is used as an adjunct to anticoagulation. CDT lowers the risk of PTS by reducing clot burden and protecting against valvular damage. A catheter is advanced directly to the site of thrombosis under fluoroscopy followed by a slow, prolonged infusion of a relatively low dose of thrombolytic agent. CDT restores venous patency faster than anticoagulation, which hastens the relief of acute symptoms. Adjunctive CDT modalities have become increasingly popular among interventional radiologists, allowing for additional mechanical thrombectomy or ultrasound-enhanced thrombolysis at the time of catheter placement. These pharmacomechanical CDT (PCDT) techniques have the potential to reduce treatment time and associated healthcare costs. Numerous observational and retrospective studies have consistently shown a benefit of CDT plus anticoagulation over anticoagulation alone for prevention of PTS. Patients with long life expectancy and acute thrombosis involving the iliac and proximal femoral veins (iliofemoral DVT) have the greatest benefit from CDT, which may decrease the risk of PTS and/or decrease the severity of PTS symptoms if they do occur. Randomized controlled trials remain limited but generally support the observational data. CDT also plays an important role in those with acute limb-threatening venous occlusion or severe symptoms from DVT. Although adverse outcomes are rare, a potential devastating outcome is intracranial bleeding. While the available literature suggests the risk of serious morbidity from bleeding is quite rare, the absolute risk of bleeding is not clear and will require outcomes data from randomized trials. Future studies should also examine the cost-effectiveness of CDT for PTS prevention, particularly with respect to quality-adjusted life years, and compare the effectiveness of available PCDT devices.

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mentioning

confidence: 99%

Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations

Fleck

Albadawi

Shamoun

et al. 2017

Cardiovasc. Diagn. Ther.

100

View full text Add to dashboard Cite

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“…Small prospective and retrospective case series suggest that the use of thrombolysis may be indicated for occlusive, symptomatic iliofemoral or inferior vena cava DVT to acutely decrease pain and improve function and, long-term, to potentially decrease the risk of (PTS) ( 31 , 33 , 38 ). Thrombolysis has been shown to decrease PTS in adults ( 40 ). Venous compression syndromes such as May-Thurner ( 41 , 42 ) and Paget Schroetter ( 43 ) (effort thrombosis) have also been treated with combined thrombolysis and endovascular or surgical techniques.…”

Section: Indications and Patient Selectionmentioning

confidence: 99%

Pediatric Thrombolysis: A Practical Approach

Tarango

Manco‐Johnson

2017

Front. Pediatr.

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The incidence of pediatric venous thromboembolic disease is increasing in hospitalized children. While the mainstay of treatment of pediatric thrombosis is anticoagulation, reports on the use of systemic thrombolysis, endovascular thrombolysis, and mechanical thrombectomy have steadily been increasing in this population. Thrombolysis is indicated in the setting of life- or limb-threatening thrombosis. Thrombolysis can rapidly improve venous patency thereby quickly ameliorating acute signs and symptoms of thrombosis and may improve long-term outcomes such as postthrombotic syndrome. Systemic and endovascular thrombolysis can result in an increase in minor bleeding in pediatric patients, compared with anticoagulation alone, and major bleeding events are a continued concern. Also, endovascular treatment is invasive and requires technical expertise by interventional radiology or vascular surgery, and such expertise may be lacking at many pediatric centers. The goal of this mini-review is to summarize the current state of knowledge of thrombolysis/thrombectomy techniques, benefits, and challenges in pediatric thrombosis.

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“…Multicentre randomised trials indicate that the use of mechanical thrombolysis or thrombolysis directed by a catheter in the iliac and femoral section will have an important role in the treatment of acute DVT in the future [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…The use of this unconventional DVT treatment method requires proper selection of patients. The long-term benefits of this method of treatment are seen in young people < 65 years of age, active, symptomatic, with thrombosis in the iliofemoral segment and low risk of bleeding [1][2][3]14].…”

Section: Introductionmentioning

confidence: 99%

Use of thrombectomy aspiration in the treatment of acute venous thrombosis

Szarnecka-Sojda¹,

Miszczuk²

2018

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Objectives: This paper presents new possibilities of treatment of acute thrombosis located in proximal segments of upper and lower limb veins using transcutaneous mechanical thrombectomy and transcatheter thrombolysis. Material and methods: The procedures were carried out in patients hospitalised in the Department of Vascular Surgery of the Provincial Hospital Complex in Kielce. Qualification for the procedure was based on the prevention and treatment guidelines for venous thromboembolism in Poland and worldwide. The treatments were performed using a Penumbra Indigo thrombectomy device. The observation covers the first half of 2017. Results: Out of 24 patients hospitalised in this period due to deep vein thrombosis, six had aspiration thrombectomy; the remaining patients were treated with the traditional method. In five patients a very good treatment effect was obtained and immediate regression of swelling and pain of the limb was observed. The applied treatment significantly shortened the hospitalisation time by half on average compared to traditional treatment and did not cause significant complications except minor bleeding. During the half-year follow-up period, patients undergoing treatment did not experience any recurrence of pain, swelling, or recent thrombosis. Conclusions: Aspiration thrombectomy combined in some cases with transcatheter thrombolysis allows rapid removal of thrombi and resection of veins and leads to quick relief of symptoms, at the same time reducing hospitalisation time and immobilisation at home. Given the novel nature of the device, further observation is needed to demonstrate the safety and comparable efficacy of this method, including randomised, controlled clinical trials before any recommendations for its use can be made.

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Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis

Cited by 25 publications

References 21 publications

Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations

Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations

Pediatric Thrombolysis: A Practical Approach

Use of thrombectomy aspiration in the treatment of acute venous thrombosis

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