Preliminary results of application of percutaneous AngioJet thrombectomy in patients with acute iliofemoral deep venous thrombosis

Abstract

Objective To evaluate the percutaneous AngioJet thrombectomy in the treatment of acute iliofemoral deep venous thrombosis (DVT) . Methods A total of 15 patients with lower extremity DVT verified by color Doppler ultrasound and computed tomographic angiography (CTA) were included in the study. Inferior vena cava filter was implanted in all patients prior to the thrombectomy. Percutaneous AngioJet thrombectomy was performed after a mixture of 250 000 U of urokinase in 100 ml of normal saline for local thrombolysis in all patients for approximately 15 minutes, except for 1 patient with cerebral hemorrhage. After the thrombectomy procedure, all patients received continuous transcatheter infusion of urokinase (250 000 to 500 000 U/d) for 1 to 3 days until the thrombosis was confirmed to be completely dissolved by angiography at 24, 48 and 72 hours. Those patients with May-Thurner syndrome underwent PTA and stent implantation. Inferior vena cava filter was retrieved from the patients post procedure and the thrombolytic therapy was discontinued. The patency rate of iliofemoral venous was assessed by CTA at 1 and 6 months after the procedure. Patients were discharged with oral anticoagulation regimen for at least 6 months. The following criteria are used in the evaluation of thrombolysis: grade Ⅰ <50% thrombus removal; grade Ⅱ=50% to 90% thrombus removal, and grade Ⅲ≥90% thrombus removal. Results All 15 patients were treated by AngioJet thrombectomy device for iliofemoral DVT. Angiography after the thrombectomy procedure showed complete thrombus removal (>90%) in 9 limbs, substantial thrombus removal (50% to 90%) in 6 limbs, and partial thrombus removal (<50%) in the remaining 2 limbs. The average dosage of the urokinase used for thrombolytic therapy post thrombectomy was 1 030 000 U (500 000 to 2 750 000 U). Grade Ⅲ (complete) thrombolysis was achieved in 12 limbs and grade Ⅱ (50% to 90%) thrombolysis in 5 of limbs. A total of 7 patients who had May-Thurner syndrome underwent PTA and stent implantation. Inferior vena cava filter was removed from 12 patients (except for 1 patient with cerebral hemorrhage and 2 patients with lung carcinoma). Venous patency was confirmed by CTA in all 15 patients at 1 month and 8 patients at 6 month after the treatment. There are no major complications related to the procedure. Conclusion Percutaneous AngioJet thrombectomy with adjunctive thrombolytic therapy is an effective and safe treatment modality in patients with acute iliofemoral vein thrombosis. Key words: Venous thrombosis; Radiology ,interventional; Thrombolytic therapy