Abstract No. 356: Power Pulse Spray Pharmacomechanical Thrombectomy for the Treatment of Upper Extremity Deep Vein Thrombosis

Abstract

While upper-extremity deep vein thrombosis (UEDVT) represents 1-4% of the all DVT, it is associated with 29-40% morbidity and mortality from the pulmonary embolism (2-35%) and post-thrombotic syndrome (7-46%). Primary UEDVT (30%) is due to thrombophilia, venous compression (Paget-Schroetter syndrome) or activity-related venous trauma. Secondary UEDVT (70%) is due to central venous catheters and malignancy. Treatment options for UEDVT include anticoagulation and less frequently pharmacomechanical thrombectomy. Recently, rapid thrombectomy methods including power pulse spray pharmacomechanical thrombectomy (PPS) have been described for the extraction of the venous thrombus. The purpose of this presentation is to report a single center experience in treatment of UEDVT with PPS. Eight patients with subclavian/axillary vein thromboses (3 women and 5 men) at a tertiary academic medical center underwent PPS. Mean age was 44 years (range, 21-57 years). All patients' records were reviewed for technical success of the procedure, duration time, dosage of lytics administered, need for adjunctive treatment, and venous patency at follow up. Rheolytic pharmacomechanical thrombectomy device was performed with the AngioJet catheter (Possis Medical, Minneapolis, MN) in PPS mode. The treatment was performed in a single setting in all patients. Time range was 60 - 300 min. Mean thrombolytic dose of alteplase was 25 mg. Adjunctive procedures were required in 7/8 patients (PTA and stenting 1 and PTA alone in 6). All patients demonstrated angiographic evidence of complete thrombus extraction and venous patency. Complications included 2 hematomas at the brachial venous puncture site. None of the patients required ICU admission or overnight lytic infusion. No patients developed clinical symptoms of pulmonary embolism. At 6 month follow up all 8 patients demonstrated patent central veins. PPS pharmacomechanical thrombectomy is a minimally invasive, low-risk therapeutic option in patients with UEDVT. Clinical benefits include rapid thrombus extraction and improved venous patency. In our experience PPS for UEDVT can be performed in a single setting with an excellent safety profile.