Mechanical thrombectomy as a safe alternative to catheter directed thrombolysis for upper extremity DVT.

Abstract

BackgroundUpper extremity deep vein thrombosis (UEDVT) has been widely managed with anticoagulation and selectively with catheter directed thrombolysis (CDT) targeting prompt venous recanalization. CDT, however, comes with a bleeding risk and complex perioperative logistics. Percutaneous mechanical thrombectomy (MT) devices may simplify the procedure. However their safety and efficacy remain unknown.MethodsThe records of 14 consecutive patients with symptomatic UEDVT who underwent MT at two tertiary European centers were reviewed (2020-2025). Subclavian vein thrombosis was the principal anatomical criterion for inclusion. MT was considered primarily in young, active individuals and athletes and in patients with persistent symptoms despite anticoagulation, with symptom duration not exceeding 3 weeks. Three different devices were used for MT: The ClotTriever system (Inari Medical, Irvine, CA), the Aspirex Mechanical Aspiration Thrombectomy System (Straub Medical, Wangs, Switzerland) and the Penumbra System (Penumbra Inc, Alameda, California, USA), with or without subsequent first rib resection and venoplasty. Preoperative demographics, intraoperative details, in-hospital and follow up complications, venous patency and symptomatic relief data were collected for descriptive analysis.ResultsSingle session MT through basilic or brachial vein access was performed and successfully completed in all 14 patients (mean age 30.57 ± 11.01, 8 males). No major postoperative adverse events were noted and the patients were discharged within 1.7 ± 1.20 days on low molecular weight heparin. One patient experienced 30-day rethrombosis. Among the 14 patients, 6 patients underwent subsequent first rib resection. Patients received full anticoagulation for 3-6 months. At an average 26.07 ± 13.5 month follow up, 9 out of 14 patients were completely free of symptoms without UEDVT recurrence.ConclusionFor the management of symptomatic UEDVT, mechanical thrombectomy using current technologies is feasible with high technical and clinical success. Larger series are required to validate our results.