ORIGINAL ARTICLE   

Acta Phlebologica 2021 December;22(3):84-99

DOI: 10.23736/S1593-232X.21.00500-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

AngioJet and Aspirex thrombectomy versus thrombolysis for acute iliofemoral deep vein thrombosis. A multi-center retrospective comparative evaluation of three therapeutic interventional modalities

Ahmed K. ALLAM ^{1, 2} ✉, Haitham S. AFIFI ¹, Medhat E. EL-LABOUDY ^{3, 4}, Abdulrahman M. AHMED ⁵

¹ Department of General Surgery, Benha University Hospitals, Benha, Egypt; ² Department of Vascular Surgery, Nile Insurance Hospital, Shoubra El-Kheima, Egypt; ³ Department of Vascular Surgery, Zagazig University Hospitals, Zagazig, Egypt; ⁴ Department of Vascular Surgery, Alnoor Specialist Hospital, Makah, Saudi Arabia; ⁵ Department of Vascular Surgery, Ain Shams University Hospitals, Cairo, Egypt

BACKGROUND: Deep venous system diseases remained out of the scope of vascular surgeons’ interest for decades except for conservative therapy. Regarding venous thromboembolism (VTE), anticoagulants were and still the primary therapy in spite of documented thrombus related long-term sequalae. Percutaneous thrombus removal becomes the first therapeutic option for lower extremity extensive DVT when not contraindicated. The goal of our study was to evaluate the outcome of patients treated with AngioJet pharmacomechanical thrombectomy (APMT) and Aspirex mechanical thrombectomy (AMT) catheter vs. pharmacological catheter directed lysis (CDT) alone.
METHODS: We analyzed 49 patients retrospectively with extensive lower extremity DVT treated with thrombus removal techniques as first therapeutic option from January 2016 to December 2019. Our measured outcomes were successful regaining vessel patency, lytic drug dose and exposure time evaluation and the incidence of complications as a primary endpoint. While the incidence of post-thrombotic syndrome (PTS) was the secondary endpoint at 24 months follow-up.
RESULTS: Successful regaining patency was 100% in group I (APMT), 95.8% in group II (CDT) and 90.9% in group III (AMT). There was a significant reduction in lytic drug dose, procedure time, ICU admission and total hospital stay in both group I and III compared to group II (P<0.001) with median tPA dose 10 mg, 50 mg and 10 mg in group I, II and III, respectively. The mean hospital stay in days was 2±1 in group I, 6±1 in group II, and 3±1 in group III. The overall, 6-month, 12-month and 24-month complete lysis was achieved in 40/54 limbs (74.1%), 47/54 limbs (87%) and 44/54 limbs (81.5%) respectively with no significant difference in recanalization rate among the studied groups at 6-month (P=0.705), 12-month (P=0.261) and 24-month (P=1.0) follow-up duration.
CONCLUSIONS: Percutaneous AngioJet PMT and Aspirex MT were safe and effective compared to standard CDT in terms of successful restoration of venous patency, safety, and incidence of PTS, moreover they showed significant reduction in procedure time, total dose of lytic drug used and the number of sessions that reflected on ICU admission and total hospital stay. Furthermore, PMT (AngioJet) had better results than MT (Aspirex) because of its combined action.

KEY WORDS: Venous thrombosis; Thrombectomy; Mechanical thrombolysis