Application of manual aspiration thrombectomy in the treatment of deep vein thrombosis in cancer patients: Descriptive retrospective cohort study.

Eu Hyun Kim,Ho Jong Chun,Myung Ah Lee,Byung Gil Choi,Jung Suk Oh,Hae Giu Lee,Robert Jeenchen Chen

doi:10.1371/journal.pone.0255539

Abstract

ObjectivesTo determine the outcomes and feasibility of endovascular treatment, mainly based on manual aspiration thrombectomy (MAT) with adjunctive percutaneous balloon angioplasty with or without stent deployment, for treatment of symptomatic ilio-femoral deep vein thrombosis (IFDVT) in cancer patients.Materials and methodsIn this retrospective cohort study, 135 consecutive patients (56 men; mean age, 63 years; 149 limbs) with acute (n = 113; 83.7%) and subacute to chronic (n = 22; 16.3%) symptomatic IFDVT underwent MAT-based endovascular treatment. Among them, adjunctive balloon angioplasty and stent placement was performed in 94 patients. Technical and clinical success regarding stage and cause of DVT was assessed.ResultsTechnical success (complete thrombus removal without residual thrombus or stenosis) was achieved in 89.6%, and subjective symptom improvement was stated by 71.5% of treated patients. The primary patency rates were 88.1%, 81.6%, 76.0%, 74.1% and 69.1% at 1, 3, 6, 12, and 30 months, respectively. Recurrent IFDVT occurred in 19.3% (26/135) of patients, 0.79 cases per patients-years of follow up. According to the analysis by causes of IFDVT, recurrence rate was 19.3% (11/57), 21.2% (12/57), and 14.3% (3/21) in unknown, compression/invasion of the vein by cancerous mass, and May-Thurner syndrome groups, respectively (p = 0.798). No procedure-related complication developed.ConclusionsEndovascular treatment based on MAT is a feasible treatment option with favorable outcomes and minimal risk of complication in cancer patients with symptomatic IFDVT.

Highlights

Endovascular treatment based on manual aspiration thrombectomy (MAT) is a feasible treatment option with favorable outcomes and minimal risk of complication in cancer patients with symptomatic ilio-femoral deep vein thrombosis (DVT) (IFDVT)
Cancer is one of the major risk factors for venous thromboembolism (VTE), which refers to deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) [1], with varying degree of risk depending on the primary site and histologic subtype [2]
Endovascular intervention for IFDVT is of limited use and even sometimes considered to be contraindicated in cancer patients due to uncertain or short life expectancy, the patients can definitely benefit from the endovascular treatment such as manual aspiration thrombectomy (MAT), since large thrombus burden is reduced in a relatively short procedural time [8]

Summary

Introduction

Cancer is one of the major risk factors for venous thromboembolism (VTE), which refers to deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) [1], with varying degree of risk depending on the primary site and histologic subtype [2]. Prompt interventional treatment for symptomatic IFDVT is essential to even cancer patients with a life expectancy of about one year, as it can improve their quality of life, alleviate symptoms, and prevent potentially serious complications such as massive PTE [9,10]. Another possible complication of IFDVT, post-thrombotic syndrome (PTS), can be avoided if they survive long enough [9,10]. Among many different endovascular treatment, MAT, a type of PMT in which a lot of thrombus can be removed through a large-bore catheter by applying negative pressure, is superior to other types of endovascular treatment of IFDVT in that it is cost-effective, simple, quick, readily available in clinical practice, and safe as it is free of bleeding risk [11,12]

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Conclusion