Comparison of aspiration thrombectomy to other endovascular therapies for proximal upper extremity deep venous thrombosis

Abstract

ObjectiveCatheter-directed thrombolysis (CDT) provides an effective method for clearing deep venous thrombosis (DVT). Unfortunately, CDT is associated with hemorrhagic complications. This study evaluated the technical success of the various endovascular therapies including a new mechanical aspiration thrombectomy (AT) device for the treatment of acute upper extremity DVT (UEDVT). MethodsThis single-center retrospective review included patients with acute symptomatic proximal UEDVT secondary to venous thoracic outlet syndrome. Undergoing endovascular therapy from December 2013 to June 2019. Patients were treated with a variety of methods including CDT, ultrasound-assisted thrombolysis (USAT), rheolytic thrombectomy, and AT. We evaluated outcomes for patients undergoing AT compared with nonaspiration thrombectomy (NAT) techniques. The primary outcome was technical success, defined as resolution of more than 70% of the thrombus. The secondary end point was the ability to complete the therapy in a single session. ResultsThere were 22 patients who had endovascular management of their symptomatic proximal UEDVT. All 22 patients (100%) were successfully treated with more than a 70% thrombus resolution. Ten patients underwent AT, of which 50% (5/10) had single session therapies. Twelve patients underwent NAT (three had CDT or USAT alone; three had USAT with rheolytic thrombectomy; and six had CDT followed by rheolytic thrombectomy), with single session therapy occurring in only 8.3% of the NAT group (1/12). The average total dose of thrombolytics was 12.6 ± 9.65 mg in the AT group compared with 19.0 ± 5.78 mg in the NAT group (mean difference, –6.4; 95% confidence interval, –1.1 to 13.9). All but one of the patients in the AT group went on to have successful first rib resections. All NAT patients had successful first rib resections. A venogram was not performed at the time of decompression. All patients except one underwent resection via the infraclavicular approach, with rib removal posterior to the brachial plexus, a median of 8.0 (interquartile range, 6.0-12.0) days after DVT therapy. ConclusionsIn this study, a technical success rate of 100% was achieved for acute symptomatic proximal UEDVT therapies. AT technology allows for higher rates of treatment in a single session, thereby minimizing a patient's risks of bleeding complications. More research is needed to further define the role of this new technology in the treatment paradigm of UEDVT management.