The efficacy of rotational pharmaco-mechanical thrombectomy in patients with acute iliofemoral deep vein thrombosis: is the standard treatment of deep vein thrombosis changing?

Abstract

Pharmacomecanical thrombectomy with the Cleaner thrombectomy device (Argon Medical Devices, Frisco, Tex) was safe and beneficial in the treatment of acute iliofemoral deep vein thrombosis (DVT). This study retrospectively evaluated 75 patients with acute DVT involving the iliofemoral segment who underwent pharmacomechanical thrombectomy with the Cleaner thrombectomy device (Argon Medical Devices). Approximately 91% had complete thrombus resolution, and >90% could be treated in a single session. Short-term improvement occurred in post-thrombotic syndrome assessed via Villalta scores; however, the scores worsened over time. This study seems to be of another “me too” mechanical thrombectomy device that removes acute soft thrombus efficiently using a strong rotating wire that macerates the thrombus, delivers thrombolytic agents, and, basically, scrapes thrombus from the venous endothelium. The advertisements for the device state that is effective with adherent thrombus but with a reduction in the risk of endothelial damage. What data are available to support this statement, which seems to have been a common one made by the manufacturers of various thrombectomy devices during the past almost 20 years? We know that post-thrombotic syndrome can appear anywhere from 6 months to 20 years after an acute DVT. How long do the investigators plan to monitor this small group of patients? Perhaps this device is efficacious in cleaning out synthetic dialysis grafts or lower extremity bypass conduits. However, it is difficult to imagine a “powerful” wire whipping around in a delicate vein already damaged by thrombus. I am concerned additional recurrent DVTs could develop once anticoagulation therapy has been discontinued owing to the increased endothelial damage. Of course, I also have no data to support this statement.