Initial Experience of Aspiration Thrombectomy using the Indigo Aspiration System for Acute Iliofemoral Deep Vein Thrombosis
Keywords:
Deep Vein Thrombosis, Iliofemoral, Thrombectomy, Aspiration ThrombectomyAbstract
Objective: The objective of this study was to report initial experience using aspiration thrombectomy with the Indigo Aspiration System, as the first line treatment for acute iliofemoral deep vein thrombosis (DVT). Methods: This study is a retrospective case review of patients with acute symptomatic iliofemoral DVT who underwent aspiration thrombectomy using the Indigo Aspiration System between December 2015 and January 2018 at three centres. Data on patient demographics, adjunctive treatments, andintraprocedural
complications were collected from electronic patient records. Technical success was defined as antegrade flow and maximal luminal stenosis of 30% assessed following the use of Indigo System. Clinical and imaging follow-up was conducted at 30 days and 12-months.
Results: A total of 35 patients (20 females; median age 43 years) met study criteria. Technical success was achieved in 80% (28/35) of patients, with the Indigo System alone. There were no intra-procedure or immediate post-procedure complications. Adjunctive interventions included venous stents (with post-dilatation) in 97.1% of patients, thrombolytics in 37.1% of patients, and caval filters in 14.2% of patients. No DVT recurrence, pulmonary embolism, or deaths occurred over
12 months of follow-up except for one patient with active neo-plastic disease. Moderate to severe post-thrombotic syndrome occurred in two patients. Conclusion: This study provides evidence that aspiration thrombectomy using the Indigo System is an effective treatment for acute iliofemoral DVT. There were no procedural complications and complication rates over the 12-month follow-up period were low
References
Meissner MH, Wakefield TW, Ascher E, Caprini JA, Comerota AJ, et al. “Acute venous disease: venous thrombosis and venous trauma”. J Vasc Surg 46(2007):25-53.
Huynh N, Fares WH, Brownson K, Brahmandam A, Lee AI, et al. “Risk factors for presence and severity of pulmonary embolism in patients with deep venous thrombosis”. J Vasc Surg Venous Lymphat Disord 6(2018):7-12.
Asbeutah AM, Riha AZ, Cameron JD, McGrath BP. “Five-year outcome study of deep vein thrombosis in the lower limbs”. J Vasc Surg 40(2004):1184-1189.
Kohi MP, Kohlbrenner R, Kolli KP, Lehrman E, Taylor AG, et al. “Catheter directed interventions for acute deep vein thrombosis”. Cardiovasc Diagn Ther 6(2016):599-611.
Vedantham S, Goldhaber SZ, Julian JA, Kahn SR, Jaff MR, et al.“Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis”. N Engl J Med 377(2017):2240-2252.
Rao AS, Konig G, Leers SA, Cho J, Rhee RY, et al. “Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis: an alternative in patients with contraindications to thrombolysis”. J Vasc Surg 50(2009):1092-1098.
Garcia MJ, Lookstein R, Malhotra R, Amin A, Blitz LR, et al. “Endovascular management of deep vein thrombosis with rheolytic thrombectomy: final report of the prospective multicenter PEARL (Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths) registry”. J Vasc Interv Radiol 26(2015):777-785.
Cakir V, Gulcu A, Akay E, Capar AE, Gencpinar T, 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 37(2014):969-976.
Ciampi-Dopazo JJ, Romeu-Prieto JM, Sanchez-Casado M, Romerosa B, Canabal A, et al. “Aspiration thrombectomy for treatment of acute massive and submassive pulmonary embolism: initial single-center prospective experience”. J Vasc Interv Radiol 29(2018):101-106.
Lopez R, DeMartino R, Fleming M, Bjarnason H, Neisen M. “Aspiration thrombectomy for acute iliofemoral or central deep venous thrombosis”. J Vascular Surg Venous Lymph Dis 7(2019):162-168.
Jabaar AA, Jenkins JS. “The role of vacuum assisted thrombectomy (AngioVac) in treating chronic venous thromboembolic disease”. Systematic review and a single center’s experience. Cardiovasc Revasc Med 19(2018):799-804.
Kim HO, Kim JK, Park JG, Yim NY, Kang YJ, et al. “Inferior vena cava filter insertion through the popliteal vein: enabling the percutaneous endovenous intervention of deep vein thrombosis with a single venous access approach in a single session”. Diagn Interv Radiol 22(2016):455-459.
Semba CP, Dake MD. “Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis”. Radiology 191(1994):487-494.
Bisdas T, Stavroulakis K, Beropoulis E, Schwindt A, Stachmann A, Austermann M, et al.“Initial experience with the 6-F and 8-F Indigo thrombectomy system for acute renovisceral occlusive events”. J Endovasc Ther 24(2017): 604-610.
Gartner T, Beropoulis E, Wendl R, Hanke JS, Dogan, et al. “In vitro study for the evaluation of transluminal aspiration as a novel treatment option for thrombosis in the Heart Ware HVAD”. Int J Artif Organs 41(2018):764-771.
Kwon SH, Oh JH, Seo TS, Ahn HJ, Park HC. “Percutaneous aspiration thrombectomy for the treatment of acute lower extremity deep vein thrombosis: is thrombolysis needed?”. Clin Radiol 64(2009):484-490.
Oguzkurt L, Ozkan U, Gulcan O, Koca N, Gur S. “Endovascular treatment of acute and subacute iliofemoral deep venous thrombosis by using manual aspiration thrombectomy: long-term results of 139 patients in a single center”. Diagn Interv Radiol 18(2012):410-416.
Zhu QH, Zhou CY, Chen Y, Wang J, Mo HY, 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.47(2014):68-74. DOI: 10.47755/J Clin Case Stud Rev.2021.1.007
Vedantham S, Goldhaber SZ, Kahn SR, Julian J, Magnuson E, et al. “Rationale and design of the ATTRACT Study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis”. Am Heart J 165(2013):523-530.
