Early and mid-term outcomes of patients treated with catheter-directed thrombolysis combined with percutaneous rotational mechanical thrombectomy for deep vein thrombosis

Abstract

Aim: Deep vein thrombosis (DVT) is an important disease that may cause serious morbidity and mortality. In the current study, we aimed to evaluate the employability of the mechanical thrombectomy and combination of it with catheter-directed thrombolysis in selected patients with acute and/or subacute DVT. Material and Methods: We applied mechanical thrombectomy and catheter-directed thrombolysis in the patients who admitted with an index diagnosis of lower extremity acute and/or subacute DVT. The thrombus in the femoral vein and iliac vein was intervened by intervention from the popliteal vein. Afterwards, mechanical thrombectomy and catheter-directed tPA infusion for 24 hours were applied. In follow-up, patients were evaluated through physical examination and Doppler ultrasonography on the 1st_, 6th_, 12th_, and 18th_month follow up, and scored with Villalta. Results: The mean age was 59.9 years. Twenty-six and 21 of the 47 patients were male and female, respectively. In the 1st-month follow-up visit, there was ≥50% patency in 43 patients, and ≥90% patency in 30 patients. During the 18-month follow-up period, while three patients had recurrent DVT, one patient had a new DVT episode in the contralateral extremity. According to Villalta score, three patients were found to have post-thrombotic syndrome (PTS) at the end of 18 months. Conclusion: We think that; pulmonary embolism (PE) and PTS rates would decrease with the concomitant application of percutaneous interventions to medical treatment in patients with index DVT diagnosis. Additionally, although the cost of percutaneous interventions seems to be high, it would be much more cost effective in the long-term when the complications related to DVT are taken into account. We also think that lowering the burden of thrombus in the acute period would preclude development of long-term complications.