BackgroundInherent to mechanical thrombectomy devices is the lack of “complete” thrombus removal resulting in the need for catheter-directed thrombosis (CDT). Our goal is to evaluate the efficacy of the RAPID thrombectomy technique for the treatment of acute deep venous thrombosis (DVT).MethodsA single-center registry of 313 lower extremities in 301 patients treated for acute DVT between 1999 and 2012 was reviewed. Patients underwent pharmacomechanical thrombectomy (PMT) using the RAPID thrombectomy technique, which involves a 6F rheolytic thrombectomy catheter placed coaxially through a directional 8F guiding catheter used in a spiraling fashion, allowing for wall-to-wall thrombectomy. Extent of clot removal and the need for adjunctive CDT, percutaneous transluminal angioplasty, and stenting were evaluated venographically. Follow-up with ultrasound was performed.ResultsA total of 92 limbs demonstrated femoropopliteal DVT, while 221 had iliofemoral DVT, with IVC involvement in 57. Thrombectomy by venography was complete (>90% removal + flow) in 203 (65%), substantial (50% to 90% removal + flow) in 75 (24%), partial (<50%) in 31 (10%), and minimal in 4 (1%) limbs following initial PMT. Flow was successfully restored in 90%. A total of 166 (53%) patients underwent additional CDT with an average infusion time of 17.7 hours; 47% of cases were completed in one session. Eighty-six percent were completed in <24 hours. Stenting was performed in 106 (34%) limbs. Binary patency by ultrasound was 94%, 90%, and 77% at 3, 6, and 12 months.ConclusionsThe RAPID thrombectomy technique is effective for rapid removal of thrombus in patients with acute DVT with significant reduction, in the need for, and length of, CDT. BackgroundInherent to mechanical thrombectomy devices is the lack of “complete” thrombus removal resulting in the need for catheter-directed thrombosis (CDT). Our goal is to evaluate the efficacy of the RAPID thrombectomy technique for the treatment of acute deep venous thrombosis (DVT). Inherent to mechanical thrombectomy devices is the lack of “complete” thrombus removal resulting in the need for catheter-directed thrombosis (CDT). Our goal is to evaluate the efficacy of the RAPID thrombectomy technique for the treatment of acute deep venous thrombosis (DVT). MethodsA single-center registry of 313 lower extremities in 301 patients treated for acute DVT between 1999 and 2012 was reviewed. Patients underwent pharmacomechanical thrombectomy (PMT) using the RAPID thrombectomy technique, which involves a 6F rheolytic thrombectomy catheter placed coaxially through a directional 8F guiding catheter used in a spiraling fashion, allowing for wall-to-wall thrombectomy. Extent of clot removal and the need for adjunctive CDT, percutaneous transluminal angioplasty, and stenting were evaluated venographically. Follow-up with ultrasound was performed. A single-center registry of 313 lower extremities in 301 patients treated for acute DVT between 1999 and 2012 was reviewed. Patients underwent pharmacomechanical thrombectomy (PMT) using the RAPID thrombectomy technique, which involves a 6F rheolytic thrombectomy catheter placed coaxially through a directional 8F guiding catheter used in a spiraling fashion, allowing for wall-to-wall thrombectomy. Extent of clot removal and the need for adjunctive CDT, percutaneous transluminal angioplasty, and stenting were evaluated venographically. Follow-up with ultrasound was performed. ResultsA total of 92 limbs demonstrated femoropopliteal DVT, while 221 had iliofemoral DVT, with IVC involvement in 57. Thrombectomy by venography was complete (>90% removal + flow) in 203 (65%), substantial (50% to 90% removal + flow) in 75 (24%), partial (<50%) in 31 (10%), and minimal in 4 (1%) limbs following initial PMT. Flow was successfully restored in 90%. A total of 166 (53%) patients underwent additional CDT with an average infusion time of 17.7 hours; 47% of cases were completed in one session. Eighty-six percent were completed in <24 hours. Stenting was performed in 106 (34%) limbs. Binary patency by ultrasound was 94%, 90%, and 77% at 3, 6, and 12 months. A total of 92 limbs demonstrated femoropopliteal DVT, while 221 had iliofemoral DVT, with IVC involvement in 57. Thrombectomy by venography was complete (>90% removal + flow) in 203 (65%), substantial (50% to 90% removal + flow) in 75 (24%), partial (<50%) in 31 (10%), and minimal in 4 (1%) limbs following initial PMT. Flow was successfully restored in 90%. A total of 166 (53%) patients underwent additional CDT with an average infusion time of 17.7 hours; 47% of cases were completed in one session. Eighty-six percent were completed in <24 hours. Stenting was performed in 106 (34%) limbs. Binary patency by ultrasound was 94%, 90%, and 77% at 3, 6, and 12 months. ConclusionsThe RAPID thrombectomy technique is effective for rapid removal of thrombus in patients with acute DVT with significant reduction, in the need for, and length of, CDT. The RAPID thrombectomy technique is effective for rapid removal of thrombus in patients with acute DVT with significant reduction, in the need for, and length of, CDT.