Percutaneous AngioJet thrombectomy in the management of extensive deep venous thrombosis

PURPOSE: This study was undertaken to evaluate the efficacy of a percutaneo us mechanical thrombectomy (PMT) device for rapid thrombus removal followin g deep venous thrombosis (DVT). MATERIALS AND METHODS: Over a 37-month period, 17 patients (14 women; mean age, 41 y +/- 20) with extensive DVT were treated with initial attempts at PMT with use of the AngioJet rheolytic thrombectomy device. Sites of venous thrombosis included lower extremities in 14 patients and upper extremity a nd brachiocephalic veins in three. The etiology for venous thrombosis was m alignancy in seven, idiopathic etiology in three, May-Thurner syndrome and immobilization in three each, and oral contraceptive use and hypercoagulabl e disorder in one each. The primary endpoint was venographic evidence of th rombus extraction. Perioperative complications, mortality, and recurrence-f ree survival were also evaluated. RESULTS: After PMT, four of 17 patients (24%) had venographic evidence of > 90% thrombus removal, six of 17 (35%) had 50%-90% thrombus removal, and sev en of 17 (41%) had <50% thrombus extraction. Adjunctive thrombolytic therap y was used in nine of 13 patients with <90% thrombus extraction by PMT; six patients (35%) had contraindications to pharmacologic thrombolytic therapy . An underlying lesion responsible for the occlusion was uncovered in 10 pa tients (59%). Significant improvement in clinical symptoms was seen in 14 o f 17 patients (82%). No complications were noted directly relating to the u se of the AngioJet thrombectomy catheter. None of the patients were lost to follow-up during a mean of 8.9 months +/- 5.3 (range, 2-21 months). At 4 a nd 11 months, recurrence-free survival rates were 81.6% and 51.8%, respecti vely. CONCLUSION: PMT with adjunctive thrombolytic therapy is a minimally invasiv e, low-risk therapeutic option in patients with extensive DVT, associated w ith clinical benefits including thrombus removal, patency, and relief of sy mptoms.