Hybrid operative thrombectomy is noninferior to percutaneous techniques for the treatment of acute iliofemoral deep venous thrombosis.

Abstract

Hybrid operative thrombectomy (HOT) is a novel technique for the treatment of acute iliofemoral deep venous thrombosis (IFDVT) and is an alternative to percutaneous techniques (PTs) that use thrombolytics. In this study, we compare perioperative and intermediate outcomes of HOT vs PT as interventions for early thrombus removal. From July 2008 to May 2015, there were 71 consecutive patients who were treated with either PT (n= 31) or HOT (n= 40) for acute or subacute single-limb IFDVT. HOT consisted of surgical thrombectomy with balloon angioplasty with or without stenting by a single incision and fluoroscopically guided retrograde valve manipulation to extract the thrombus. PT included catheter-directed thrombolysis with or without pharmacomechanical thrombectomy using the Trellis-8 system (Bacchus Vascular, Santa Clara, Calif). Patients who presented with bilateral DVT (n= 4), inferior vena cava involvement (n= 8), or venous gangrene (n= 1) were excluded. Perioperative outcomes, quality measures, and thrombus resolution were compared between the two treatment groups. Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification, Villalta score, and venous duplex ultrasound at intermediate follow-up were also analyzed. The left limb was the most common site of the IFDVT overall. Technical success (≥50% resolution) was 100% for both groups, and >80% resolution was achieved in all patients treated with HOT. There were eight major bleeding events in the PT group compared with three in the HOT group (P= .04). PT patients had a significantly longer length of stay (13 vs 10 days; P= .028) compared with HOT. At 2-year duplex ultrasound examination, there was no difference between HOT and PT in mean reflux times at the femoral-popliteal segment. At 2 years, 85% and 87% of the patients (HOT vs PT, respectively) had not developed post-thrombotic syndrome, and there was no difference between the groups for mean Villalta score (2.1± 1.9 vs 2.3± 2; P= .79). PT and HOT have demonstrated good outcomes in the perioperative and intermediate periods. HOT is noninferior to PT as a technique for early thrombus removal and has the advantages that thrombus resolution is established in one operation and length of stay is significantly decreased. HOT avoids thrombolytic therapy, which may reduce major bleeding events.