Effect of percutaneous mechanical thrombectomy combined with subsequent iliac vein stent implantation in treatment of acute lower extremity deep venous thrombosis with iliac vein compression syndrome

Abstract

Objective: To evaluate the feasibility, safety and effectiveness of percutaneous mechanical thrombectomy (PMT) combined with subsequent iliac vein stent implantation in treating acute deep venous thrombosis (DVT) with iliac vein compression syndrome (IVCS) . Methods: During the period from April 2015 to July 2017, 33 patients who had acute DVT with IVCS, including 13 males and 20 females with a mean age of (57.97±14.44) years old, were admitted to The First Affiliated Hospital of Soochow University. The disease time was 6 h-14 d. Inferior vena cava filters were implanted in all patients prior to the treatment. AngioJet thrombectomy, balloon angioplasty and iliac vein stent implantation were performed in the same setting. All patients received continuous transcatheter infusion of urokinase until the thrombosis was confirmed to be completely dissolved. The patients were followed up at outpatient clinic at 1, 3, 6 and 12 months after treatment, and the reexamination of color ultrasound and/or lower limb venography were used to assess the blood flow in deep veins and stents. Results: The combination of several therapies was accomplished in a single session, the technical success rate was 100%. The procedure time for AngioJet thrombectomy was (224.70±72.78) s. The thrombolysis time was (34.00±15.37) h. The total used dosage of urokinase was (112.58±49.92) ×104 U. Thirty-three stents were implanted directly after thrombectomy in 33 patients. Angiography postoperatively showed thrombus clearance rate of grade Ⅲ was obtained in 29 patients and was grade Ⅱ in four patients. There were no serious complications such as pulmonary embolism, severe hemorrhage, etc. Relapse of DVT was observed in one patient, color ultrasound and/or lower limb venography performed in the other 32 patients showed that the blood flow in deep veins and iliac vein stents was unobstructed. Conclusion: For the treatment of acute lower extremity DVT with IVCS, PMT combined with iliac vein stent implantation accomplished by single-session is safe and feasible. Key words: Iliac vein compression syndrome; Deep vein thrombosis; Percutaneous mechanical thrombectomy; Endovascular treatment