Single-Session Pharmacomechanical Catheter-Directed Thrombolysis Using the JETi Thrombectomy Device for Acute Iliofemoral Deep Vein Thrombosis Refractory to Therapeutic Anticoagulation

Background: The risk of complications and discomfort in patients who undergo prolonged infusion of a thrombolytic agent is significant when conventional catheter-directed thrombolysis is used to treat lower extremity deep vein thrombosis (DVT). Purpose: To evaluate the feasibility and safety of single-session endovascular treatment for symptomatic lower extremity DVT. Material and Methods: Single-session endovascular treatment for lower extremity DVT was performed on 29 limbs in 26 patients diagnosed with acute DVT in our institution. Nine patients were male and 17 female, with a mean age of 64 years (range 28–82 years). At 5–10 min after the locoregional injection of the thrombolytic agent (urokinase) via a 5-Fr catheter to soften the thrombus, aspiration thrombectomy was performed with a large-bore sheath. In patients with an underlying anatomical stenosis or obstruction, combined angioplasty with or without stent placement was performed immediately after the complete removal of the thrombus. We then evaluated the technical and clinical outcomes of the procedure, along with any complications or recurrences of DVT. Results: Technical success was achieved in 24 procedures (82.8%) of single-session endovascular treatment for lower extremity DVT, and clinical success was achieved in 22 (75.9%) of these single-session procedures. Additional catheter-directed thrombolysis procedures were performed on five limbs after repeated aspiration thrombectomies failed to completely remove thrombi in those limbs. Stenotic or occlusive lesions were revealed in 24 limbs and percutaneous angioplasty procedures with or without stent placement were performed in these cases. No major complications resulted from the procedure. Conclusion: Single-session endovascular treatment is a feasible technique that provides acceptable technical and clinical success with excellent safety for treating symptomatic lower extremity DVT.

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Early clinical outcomes of a novel rheolytic directional thrombectomy technique for patients with iliofemoral deep vein thrombosis

VASA ◽

10.1024/0301-1526/a000666 ◽

2018 ◽

Vol 47 (1) ◽

pp. 56-62 ◽

Cited By ~ 12

Author(s):

Jörn F. Dopheide ◽

Tim Sebastian ◽

Rolf P. Engelberger ◽

Axel Haine ◽

Nils Kucher

Keyword(s):

Deep Vein Thrombosis ◽

Stent Thrombosis ◽

Stent Placement ◽

Treatment Success ◽

Primary Treatment ◽

Primary Patency ◽

Single Session ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Deep Vein

Abstract. Background: Rheolytic thrombectomy (RT) for acute iliofemoral deep vein thrombosis (DVT) with first-generation techniques is often incomplete and adjunctive conventional catheter-directed thrombolysis (CDT) is required in more than half of patients to achieve venous patency. Patients and methods: From the prospective Bern Venous Stent Registry, we investigated rates of primary treatment success, primary patency, and post-thrombotic syndrome (PTS) from 40 consecutive patients (mean age 51 ± 19 years, 45 % women) with acute iliofemoral DVT, treated with a novel directional RT technology and stent placement. Overall, 24 patients were treated for native-vessel iliofemoral DVT (11 with single-session RT, 13 with bail-out RT after failed CDT) and 16 for iliofemoral stent thrombosis. Pulse-spray thrombolysis (r-tPA 10 mg) was performed in 29 (73 %) patients. The mean follow-up duration was 193 ± 132 days (minimum 90 days). Results: Overall, primary treatment success of RT was 95 %; only two patients required adjunctive CDT to restore patency. In 24 patients with native-vessel DVT, six-month primary patency was 92 % (95 %CI 75–99 %), and 23 patients (96 %) were free from the PTS according to the Villalta score. In 16 patients with stent thrombosis, six-month primary patency was 63 % (95 %CI 35–85 %) and 50 % were free from PTS. Except for transient macroscopic haemoglobinuria in all patients, no other side effects were recorded. Conclusions: In patients with iliofemoral DVT of native or stented vessels, RT followed by stent placement appears to be effective and safe. The novel technique enables single-session DVT treatment in the majority of patients without the need for prolonged CDT.

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First-in-human experience of the Bashir Endovascular Catheter in the treatment of iliocaval deep vein thrombosis

Vascular Medicine ◽

10.1177/1358863x211028287 ◽

2021 ◽

pp. 1358863X2110282

Author(s):

Mohamad Al-Otaibi ◽

Neal B Shah ◽

Omer Iftikhar ◽

Prateek Sharma ◽

Koneti Rao ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Vena Cava ◽

Case Series ◽

The United States ◽

Bleeding Complications ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Therapeutic Anticoagulation ◽

Catheter Design ◽

Deep Vein

Deep vein thrombosis (DVT) is a common disorder affecting approximately 900,000 new patients in the United States each year. Although the mainstay of treatment of DVT patients is therapeutic anticoagulation, some patients remain significantly symptomatic and therefore require more advanced interventions such as catheter-directed thrombolysis (CDT). We describe a case series of 13 patients with acute symptomatic inferior vena cava (IVC) and iliofemoral DVT that were treated with CDT using the Bashir Endovascular Catheter (BEC). We report the first-in-human use of BEC, which is a novel pharmacomechanical thrombolysis device. All the treated patients had complete and rapid resolution of their symptoms with excellent venous outflow. Despite initial promising results, larger studies using this catheter design will be needed to assess the role of BEC-directed therapy on rates of post-thrombotic syndrome and bleeding complications.

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Pharmacomechanical Thrombectomy for Acute Symptomatic Lower Extremity Deep Venous Thrombosis

The Heart Surgery Forum ◽

10.1532/hsf.1366 ◽

2015 ◽

Vol 18 (4) ◽

pp. 178 ◽

Cited By ~ 2

Author(s):

Eyup Serhat Calik ◽

Ozgur Dag ◽

Mehmet Ali Kaygin ◽

Oruc Alper Onk ◽

Bilgehan Erkut

Keyword(s):

Deep Vein Thrombosis ◽

Lower Extremity ◽

Venous Thrombosis ◽

Large Scale ◽

Single Session ◽

Vein Thrombosis ◽

Thrombectomy Device ◽

Acute Deep Vein Thrombosis ◽

Deep Vein ◽

Grade Iii

Background: The purpose of this study was to evaluate the efficacy and safety of pharmacomechanical thrombectomy performed by using a rotational thrombectomy device for the treatment of deep vein thrombosis. Methods: Between April 2012 and November 2014, 17 patients with acute deep vein thrombosis underwent pharmacomechanical thrombolysis. The thrombectomy device was used in a single-session technique for patients with lower-extremity deep vein thrombosis. After the procedure, the effect of thrombolysis was evaluated in 3 grades venographically. Grade I showed lysis of under 50%, and grade III showed complete lysis. Results: Ten patients (58.8%) had an iliofemoral thrombosis and 7 (41.2%) had a femoropopliteal venous thrombosis. At the end of the pharmacomechanical thrombectomy procedure, 12 patients (70%) had complete (grade III) thrombus resolution. Grade I and II lysis were noted in 2 (12%) and 3 (18%) patients, respectively. Additionally, four (23.5%) required an additional lytic infusion as a result of residual thrombi. The overall grade III, II, and I thrombus resolution rates, including the supplemental thrombolysis, were 82.2% (n = 14), 12% (n = 2), and 5.8% (n = 1), respectively. There was no mortality. Conclusion: Based on the present data, use of the Cleaner thrombectomy device may prove to be a safe and feasible single-session pharmacomechanical thrombectomy method for the treatment of acute deep vein thrombosis. To prove the effectiveness of this type treatment, a more extensive large-scale studies are needed.

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Single-Session Thrombolysis-Free Treatment of Deep Vein Thrombosis With a Novel Mechanical Thrombectomy Device

JACC: Case Reports ◽

10.1016/j.jaccas.2020.12.049 ◽

2021 ◽

Vol 3 (3) ◽

pp. 415-420

Author(s):

Adam Raskin ◽

Amitesh Verma ◽

Timothy D. Brennan

Keyword(s):

Deep Vein Thrombosis ◽

Mechanical Thrombectomy ◽

Single Session ◽

Vein Thrombosis ◽

Free Treatment ◽

Thrombectomy Device ◽

Deep Vein

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Feasibility Study of Catheter-directed Thrombolysis with Recombinant Staphylokinase in Deep Venous Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614936 ◽

1998 ◽

Vol 79 (03) ◽

pp. 517-519 ◽

Cited By ~ 13

Author(s):

Stephane Heymans ◽

Raymond Verhaeghe ◽

Luc Stockx ◽

Désiré Collen

Keyword(s):

Deep Vein Thrombosis ◽

Continuous Infusion ◽

High Speed ◽

Minor Bleeding ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Long Term Follow Up ◽

Valve Function ◽

Rotating Impeller ◽

Deep Vein

SummaryThe feasibility of catheter-directed thrombolysis with recombinant staphylokinase was evaluated in six selected patients with deep vein thrombosis. The patients underwent intrathrombus infusion of recombinant staphylokinase (2 mg bolus followed by a continuous infusion of 1 mg/h). Heparin was given via the catheter as a bolus (5000 U) and as a continuous infusion (1000 U/h). Complete lyis was obtained in five patients and partial lysis in one patient. Complications consisted of minor bleeding in four subjects. Symptomatic reocclusion occurred in one. Debulking of the thrombus mass by a high speed rotating impeller (n = 1) and stenting (n = 3) were used as additional interventions. An underlying anatomical abnormality was present in two patients. Long term follow up revealed normal patency in all patients and normal valve function in four patients. Symptomatic venous insufficiency with valve dysfunction was present in the two with a second thrombotic episode.Thus catheter-directed infusion of recombinant staphylokinase in patients with deep vein thrombosis appears feasible and may be associated with a high frequency of thrombolysis. Larger studies to define the clinical benefit of this treatment appear to be warranted.

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