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Efficacy of Mechanical Thrombectomy in Preventing Post-Thrombotic Syndrome in Acute DVT: A Retrospective Study.

ABSTRACT: Background Lower limb deep vein thrombosis (DVT) is associated with significant morbidity and death. DVT can result in complications such as postphlebitic syndrome, pulmonary embolism, and death. Combining pretest probability, D-dimer testing, and compression ultrasound imaging enables a safe and convenient study of suspected lower-extremity thrombosis. This study aimed to assess the expanding body of research supporting thrombectomy as a form of DVT therapy. Materials and Methods A retrospective study was performed on individuals with venous Doppler-confirmed DVT and occlusive thrombus. Four-hundred fifty-one consecutive patients were selected for the study based on the inclusion and exclusion criteria. In this investigation, thrombectomy was the preferred therapeutic approach. Results The study reports a male predominance of 56.1%. Most patients (25.7%) were between the age of 51 and 60, with 84.7% reporting pain and lower-extremity swelling as the two most common clinical symptoms. The femoral vein was noted as the most frequent site of thrombus in the current research (51.0%), with acute DVT accounting for most cases (85.1%). Most of the patients (97.3%) were primarily asymptomatic after one year of follow-up. Conclusion Thrombectomy is a reliable treatment modality for DVT patients in regaining venous patency, preventing DVT recurrence, treating post-thrombotic syndrome, and preventing pulmonary embolism.

SUBMITTER: Philip VK

PROVIDER: S-EPMC11319023 | biostudies-literature | 2024 Jun

REPOSITORIES: biostudies-literature

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Efficacy of Mechanical Thrombectomy in Preventing Post-Thrombotic Syndrome in Acute DVT: A Retrospective Study.

Philip Vinoth Kumar VK Yasir Mohamed B MB

Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India 20240530 3

<b>Background</b> Lower limb deep vein thrombosis (DVT) is associated with significant morbidity and death. DVT can result in complications such as postphlebitic syndrome, pulmonary embolism, and death. Combining pretest probability, D-dimer testing, and compression ultrasound imaging enables a safe and convenient study of suspected lower-extremity thrombosis. This study aimed to assess the expanding body of research supporting thrombectomy as a form of DVT therapy. <b>Materials and Methods</b> ...[more]

PMID: 39139687

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Project description:Background The CAVA (Ultrasound-Accelerated Catheter-Directed Thrombolysis Versus Anticoagulation for the Prevention of Post-Thrombotic Syndrome) trial did not show a reduction of post-thrombotic syndrome (PTS) after additional ultrasound-accelerated catheter-directed thrombolysis in patients with acute iliofemoral deep vein thrombosis at 1-year follow-up. This prespecified analysis of the CAVA trial aimed to determine the impact of additional thrombolysis on outcomes of PTS at long-term follow-up. Methods and Results Patients aged 18 to 85 years with a first-time acute iliofemoral deep vein thrombosis were included and randomly assigned (1:1) to either standard treatment plus ultrasound-accelerated catheter-directed thrombolysis or standard treatment alone. The primary outcome was the proportion of PTS (Villalta score ≥5 on 2 occasions ≥3 months apart or venous ulceration) at the final follow-up visit. Additionally, PTS according to the International Society on Thrombosis and Haemostasis (ISTH) consensus definition was assessed to allow external comparability. Major bleedings were the main safety outcome. At a median follow-up of 39.0 months (interquartile range, 23.3-63.8), 120 patients (79.8%) participated in the final follow-up visit: 62 from the intervention group and 58 from the standard treatment group. PTS developed in 19 (30.6%) versus 26 (44.8%) patients, respectively (odds ratio [OR], 0.54; 95% CI, 0.26 to 1.15 [P=0.11]), with an absolute difference between groups of -14.2% (95% CI, -32.0% to 4.8%). Using the ISTH consensus definition, a significant reduction in PTS was observed (29 [46.8%] versus 40 [69.0%]) (OR, 0.40; 95% CI, 0.19-0.84 [P=0.01]) with an absolute difference between groups of -22.2% (95% CI, -39.8% to -2.8%). No new major bleedings occurred following the 12-month follow-up. Conclusions The impact of additional ultrasound-accelerated catheter-directed thrombolysis on the prevention of PTS was found to increase with time. Although this study was limited by its sample size, the overall findings indicate a reduction of mild PTS without impact on quality of life. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00970619.

Project description:BackgroundPatients with acute and high-risk pulmonary embolism have a high mortality rate, and the optimal treatment for these patients has still not been fully established. Although anticoagulation therapy is currently the preferred treatment for pulmonary embolism, for some patients with intermediate- or high-risk pulmonary embolism, anticoagulation therapy alone has a higher probability of long-term pulmonary hypertension and also seriously worsens the quality of life of patients. This paper mainly reports the efficacy and safety of percutaneous mechanical thrombectomy (PMT) in patients with acute medium- or high-risk pulmonary embolism in Taizhou Hospital of Zhejiang Province so as to provide some clinical basis for the treatment of such patients in the future.MethodsThis study mainly collected the clinical data of 43 patients who were admitted to Taizhou Hospital of Zhejiang Province from May 2018 to May 2023 due to acute medium-to-high-risk pulmonary embolism and received PMT treatment. Preoperative and postoperative blood tests, vital signs, and echocardiographic parameters were compared. The incidence of intraoperative and postoperative complications in follow-up at 1, 6, and 12 months was also recorded. Mechanical treatment included thrombus fragmentation complemented with aspiration.ResultsAmong the 43 patients, 22 patients were treated with thrombus fragmentation coupled with a pigtail catheter and aspiration using a 6-F multipurpose angiographic (MPA) catheter, 11 were treated by AngioJet, and 10 were treated with an AcoStream catheter. Local thrombolysis treatment with small dose of urokinase was administered in some patients according to the patient's risk of bleeding. Among the patients, 41 patients received a successful operation, representing a surgical success rate of 95.3%. There was one patient with pulmonary infection who died after discharge. There were significant differences in vital signs between the 48-hour preoperative timepoint and the 48-hour postoperative timepoint including cardiac index, pulse, mean arterial pressure, and oxygen saturation (P<0.001). The blood test indicators of carbon dioxide partial pressure and creatinine level did not show obvious abnormalities, but differences in hemoglobin, oxygen partial pressure, and lactate level were statistically significant. In terms of cardiac ultrasound, pulmonary artery pressure and right atrial diameter change were significantly different (P<0.001). There were seven cases of local hematoma at the puncture site, three cases of infection at the puncture site, and nine cases of transient cardiac arrest during the operation. All 41 patients were followed up: one patient died after being discharged due to aggravation of pulmonary infection during hospitalization, one patient died of intracerebral hemorrhage 9 months after the operation, one patient developed recurrent pulmonary embolism, and five patients had no obvious improvement in chest tightness.ConclusionsPMT can be used as a safe and effective treatment option for acute medium-to-high-risk pulmonary embolism.

Project description:IntroductionPost-thrombotic syndrome (PTS) is a serious complication of deep vein thrombosis (DVT) of the leg that affects 20-50% of patients. Once a patient experiences PTS there is no treatment that effectively reduces the debilitating complaints. Two randomised controlled trials showed that elastic compression stocking (ECS) therapy after DVT for 24 months can reduce the incidence of PTS by 50%. However, it is unclear whether all patients benefit to the same extent from ECS therapy or what the optimal duration of therapy for individual patients should be. ECS therapy is costly, inconvenient, demanding and sometimes even debilitating. Tailoring therapy to individual needs could save substantial costs. The objective of the IDEAL DVT study, therefore, is to evaluate whether tailoring the duration of ECS therapy on signs and symptoms of the individual patient is a safe and effective method to prevent PTS, compared with standard ECS therapy.Methods and analysisA multicentre, single-blinded, allocation concealed, randomised, non-inferiority trial. A total of 864 consecutive patients with acute objectively documented proximal DVT of the leg are randomised to either standard duration of 24 months or tailored duration of ECS therapy following an initial therapeutic period of 6 months. Signs and symptoms of PTS are recorded at regular clinic visits. Furthermore, quality of life, costs, patient preferences and compliance are measured. The primary outcome is the proportion of patients with PTS at 24 months.Ethics and disseminationBased on current knowledge the standard application of ECS therapy is questioned. The IDEAL DVT study will address the central questions that remain unanswered: Which individual patients benefit from ECS therapy and what is the optimal individual treatment duration? Primary ethics approval was received from the Maastricht University Medical Centre.ResultsResults of the study will be disseminated via peer-reviewed publications and presentations at scientific conferences.Trial registration numberNCT01429714 and NTR 2597.

Dataset Information

Efficacy of Mechanical Thrombectomy in Preventing Post-Thrombotic Syndrome in Acute DVT: A Retrospective Study.

Publications

Efficacy of Mechanical Thrombectomy in Preventing Post-Thrombotic Syndrome in Acute DVT: A Retrospective Study.

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