Early thrombus removal through peroneal venous approach for treating acute iliofemoral deep venous thrombosis.

Abstract

Purpose: The purpose of this study was to evaluate the safety, effectiveness, and feasibility of thrombus removal using the peroneal vein (PeV) approach in acute IFDVT.

Material and methods: From May 2019 to July 2020, the acute IFDVT patients who had undergone AngioJet pharmacomechanical thrombectomy (PCDT) and/or manual aspiration thrombectomy (MAT) through PeV access were analyzed retrospectively. Clinical characteristics, operative and postoperative therapy details, and PeV access-related data were investigated. Outcome measures included thrombus removal grade, venous patency rate, and the incidence of post-thrombotic syndrome (PTS). All patients were followed up for a minimum of one year.

Results: A total of 42 patients were reviewed. The thrombus involved the popliteal vein in 85.7% (n = 36) of cases. The PeV access was successfully achieved in all patients through four puncture methods. Therein, blind puncture under fluoroscopy was used in 52.4% of patients. Postoperatively, the mean thrombolysis time was 4.8 ± 1.9 days, and the average dose of urokinase was 2.7 ± 1.0 MIU. All the patients had successfully thrombus lysis, including 9.5% of grade II lysis and 90.5% of grade III lysis. Three complications occurred during the thrombolysis treatment, including two puncture site minor bleeding and one minor gingival bleeding. During the one-year follow-up, the venous patency rate and the PTS incidence rate were 97.6% and 9.5%, respectively.

Conclusions: Thrombus removal of acute IFDVT through PeV access is safe, effective, and feasible, while large cohort studies are needed to confirm the superiority of PeV access.