Continuous Aspiration Thrombectomy of Acute Inferior Vena Cava and Inferior Vena Cava Filter Occlusions—Does It Work and Is It Safe?

Abstract

Acute thrombosis of the inferior vena cava (IVC) and IVC filters has significant morbidity. Traditional endovascular management is pharmacomechanical with varying amounts of thrombolytics. Hemorrhagic complications from thrombolytics can be life-threatening. Rheolytic thrombectomy is effective, but complications include blood loss and renal insufficiency. Continuous aspiration thrombectomy (CAT) has recently emerged as a viable option for patients with deep venous thrombosis. Early results suggest that CAT may minimize blood loss, hemorrhagic complications, and renal insufficiency. This study evaluated the safety and efficacy of CAT in treating acute IVC thrombus and acutely occluded IVC filters. This is a single-center, retrospective study conducted to analyze patients with acute IVC thrombus and acutely occluded IVC filters undergoing CAT. Patients were treated between December 2015 and September 2018. All patients underwent CAT. The primary end point was the periprocedural success, defined as an antegrade flow after CAT. Secondary end points were total lytic dose, hemorrhagic complications, and blood loss. A total of 156 vacuum-assisted thrombectomy procedures were performed. Of these, 21 procedures were performed on patients with acute DVT, 8 of whom presented with thrombus in the IVC or had an acute IVC filter occlusion. Antegrade flow was established after vacuum-assisted closure in seven of these patients. The mean preoperative and postoperative blood loss was 12.3/36.6 and 9.8/29.5, respectively. Access site hematomas were reported in two patients. No other complications, such as perforation, intracranial hemorrhage, or retroperitoneal bleeds, were reported. The range of lytic dose was 0 to 35 mg, with an average of 20.5 mg. CAT is an emerging technology for arterial and venous thromboembolism. This is the first study analyzing CAT for acute IVC thrombus and occluded IVC filters. The study results suggest that CAT is safe and promising for the treatment of acute IVC thrombosis and acutely occluded IVC filters. Further investigation is necessary to establish a protocol for CAT in patients with IVC disease.