Advertisement

Technical success and short-term results from mechanical thrombectomy for lower extremity iliofemoral deep vein thrombosis using a computer aided mechanical aspiration thrombectomy device

Published:November 22, 2021DOI:https://doi.org/10.1016/j.jvsv.2021.11.002

      Abstract

      Background

      The symptoms of deep vein thrombosis (DVT) include severe pain and swelling, and the complications can include post-thrombotic syndrome and recurrent venous thromboembolism. Aspiration thrombectomy (AT) treats arterial and venous disease by removing acute thrombus without reliance on thrombolytic agents but also has the potential to remove fresh blood. Intelligent aspiration is designed to minimize blood loss during AT by aspirating continuously in the thrombus but only intermittently when in a patent vascular segment with active flow. The Indigo System with Lightning 12 intelligent aspiration (Penumbra, Inc, Alameda, Calif) uses an automatic valve controlled by a proprietary computer algorithm to optimize thrombus removal and minimize blood loss. This computer-aided mechanical AT (CMAT) system was used for 16 consecutive patients.

      Methods

      The present retrospective review included 16 patients who had undergone CMAT for iliofemoral acute DVT from July 2020 to June 2021. The primary outcome was >70% thrombus removal as determined by multiplanar venography. The secondary outcomes included single-session therapy, blood loss during aspiration, the need for postprocedure blood transfusion, thrombolytic use, symptom resolution before discharge, and periprocedural complications.

      Results

      Sixteen patients (mean age, 58.6 years; range, 31-80 years; 75.0% women) had undergone CMAT with the Lightning 12 system. All the patients had presented with pain and swelling of 2 to 16 days in duration. No patient had presented with phlegmasia. Access was obtained via the popliteal (n = 11), posterior tibial (n = 3), small saphenous (n = 1), or soleal (n = 1) vein. Thrombus reduction of ≥70% was achieved for all 16 patients (100%). Single-session therapy was successful for 15 patients (93.8%). Eight patients (50%) had received stents. All patients had experienced symptom resolution before discharge. The median blood loss was 155.0 mL (interquartile range, 95.0-187.5), and no patient had required a postprocedure transfusion. One patient had undergone angioplasty after thrombectomy, and one patient (6.2%) had received adjunctive tissue plasminogen activator therapy. No patient had developed postoperative acute kidney failure. No periprocedural complications occurred. At 1 to 8 months of follow-up, 15 of the 16 patients (93.8%) had patency of the treated iliofemoral area, and 14 (87.5%) had no recurrent symptoms.

      Conclusions

      These results suggest that CMAT using the Lightning 12 system is safe for clot removal for patients with acute iliofemoral DVT with a high rate of single-session technical success and symptom resolution. In the present case series, the Lightning 12 system was also associated with low blood loss, and no patient had required a blood transfusion.

      Keywords

      To read this article in full you will need to make a payment
      SVS Member Login
      Society Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mazzolai L.
        • Aboyans V.
        • Ageno W.
        • Agnelli G.
        • Alatri A.
        • Bauersachs R.
        • et al.
        Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function.
        Eur Heart J. 2018; 39: 4208-4218
        • Jaff M.R.
        • McMurtry M.S.
        • Archer S.L.
        • Cushman M.
        • Goldenberg N.
        • Goldhaber S.Z.
        • et al.
        Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association.
        Circulation. 2011; 123: 1788-1830
        • Vedantham S.
        • Grassi C.J.
        • Ferral H.
        • Patel N.H.
        • Thorpe P.E.
        • Antonacci V.P.
        • et al.
        Reporting standards for endovascular treatment of lower extremity deep vein thrombosis.
        J Vasc Interv Radiol. 2006; 17: 417-434
        • Kohi M.P.
        • Kohlbrenner R.
        • Kolli K.P.
        • Lehrman E.
        • Taylor A.G.
        • Fidelman N.
        Catheter directed interventions for acute deep vein thrombosis.
        Cardiovasc Diagn Ther. 2016; 6: 599-611
        • Mewissen M.W.
        • Seabrook G.R.
        • Meissner M.H.
        • Cynamon J.
        • Labropoulos N.
        • Haughton S.H.
        Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry.
        Radiology. 1999; 211: 39-49
        • Enden T.
        • Haig Y.
        • Kløw N.-E.
        • Slagsvold C.-E.
        • Sandvik L.
        • Ghanima W.
        • et al.
        Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial.
        Lancet. 2012; 379: 31-38
        • Vedantham S.
        • Goldhaber S.Z.
        • Julian J.A.
        • Kahn S.R.
        • Jaff M.R.
        • Cohen D.J.
        • et al.
        Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis.
        N Engl J Med. 2017; 377: 2240-2252
        • Oguzkurt L.
        • Ozkan U.
        • Gulcan O.
        • Koca N.
        • Gur S.
        Endovascular treatment of acute and subacute iliofemoral deep venous thrombosis using manual aspiration thrombectomy: long-term result of 139 patients from a single center.
        Diagn Interv Radiol. 2012; 18: 410-416
        • Zhu Q.H.
        • Zhou C.Y.
        • Chen Y.
        • Wang J.
        • Mo H.Y.
        • Luo M.H.
        • et al.
        Percutaneous manual aspiration thrombectomy followed by stenting for iliac vein compression syndrome with secondary acute isolated iliofemoral deep vein thrombosis: a prospective study of single-session endovascular protocol.
        Eur J Vasc Endovasc Surg. 2014; 47: 68-74
        • Cakir V.
        • Gulcu A.
        • Akay E.
        • Capar A.E.
        • Gencpinar T.
        • Kucuk B.
        • et al.
        Use of percutaneous aspiration thrombectomy vs. anticoagulation therapy to treat acute iliofemoral venous thrombosis: 1-year follow-up results of a randomised, clinical trial.
        Cardiovasc Intervent Radiol. 2014; 37: 969-976
        • Lopez R.
        • DeMartino R.
        • Fleming M.
        • Bjarnason H.
        • Neisen M.
        Aspiration thrombectomy for acute iliofemoral or central deep venous thrombosis.
        J Vasc Surg Venous Lymphat Disord. 2019; 7: 162-168
        • Benarroch-Gampel J.
        • Pujari A.
        • Aizpuru M.
        • Rajani R.R.
        • Jordan W.D.
        • Crawford R.
        Technical success and short-term outcomes after treatment of lower extremity deep vein thrombosis with the ClotTriever system: a preliminary experience.
        J Vasc Surg Venous Lymphat Disord. 2020; 8: 174-181
        • Diniz J.
        • Coelho A.
        • Mansilha A.
        Endovascular treatment of iliofemoral deep venous thrombosis: is there enough evidence to support it? A systematic review with meta-analysis.
        Int Angiol. 2020; 39: 93-104
        • Li X.
        • Xie H.
        • Zhang Y.
        • Li H.
        Individual choice for the aspiration thrombectomy treatment of acute iliofemoral deep venous thrombosis.
        Ann Vasc Surg. 2020; 69: 237-245
        • Escobar G.A.
        • Burks D.
        • Abate M.R.
        • Faramawi M.F.
        • Ali A.T.
        • Lyons L.C.
        • et al.
        Risk of acute kidney injury after percutaneous pharmacomechanical thrombectomy using AngioJet in venous and arterial thrombosis.
        Ann Vasc Surg. 2017; 42: 238-245
        • Salem K.M.
        • Saadeddin Z.
        • Go C.
        • Malak O.A.
        • Eslami M.H.
        • Hager E.
        • et al.
        Risk factors for acute kidney injury after pharmacomechanical thrombolysis for acute deep vein thrombosis.
        J Vasc Surg Venous Lymphat Disord. 2021; 9: 868-873
        • Huasen B.
        • Khan A.
        • Suwathep P.
        • Beropoulis E.
        • Bisdas T.
        Initial experience of aspiration thrombectomy using the Indigo aspiration system for acute iliofemoral deep vein thrombosis.
        J Clin Case Stud. 2021; 1: 001-006