Early results of Percutaneous Aspiration Thrombectomy vs anticoagulation in acute Iliofemoral Venous Thrombosis. A randomised clinical trial

Deep venous thrombosis (DVT) is the clot formation due to stasis, endothelial damage and hypercoagulability, which is also known as Virchow triad. It may cause severe sequel and death if it is not treated in a timely manner.The annual incidence of DVT is 5-20 in 10.000. Despite standard anticoagulation, death secondary to pulmonary embolism can be seen in 1-8 % of the patients. In long term follow up post thrombotic syndrome and chronic thromboembolic pulmonary hypertension can be seen in 40% and 4% of the patients respectively.The most common etiological cause is immobilization, which is followed by postoperative status, malignancy and trauma. One third of the cases are defined as idiopathic. Hypercoagulability and neurological diseases are also included within the list of causes.The treatment of deep venous thrombosis aims to prevent complications like pulmonary embolism and hypertension, peripheral venous disease, recurrent venous thromboembolism and post thrombotic syndrome. Treatment is based on the use of anticoagulation, thrombolysis, surgical thrombectomy and percutaneous endovascular techniques.This study aims to compare the efficiencies of standard anticoagulation and percutaneous aspiration thrombectomy in acute iliofemoral-popliteal deep venous thrombosis.The study included patients who had a diagnosis of acute iliofemoral-popliteal thrombosis detected by Doppler ultrasonography (US) from March 2010 to January 2011. The interventional group included 26 patients (18 men, 8 women, mean age 51) whereas medical group included 21 patients (13 men, 8 women, mean age 51). The patients in the medical group received anticoagulation. Percutaneous aspiration thrombectomy (PAT) with a wide lumen guide catheter (9 F) was the standard treatment in the interventional group. In this group balloon angioplasty (23 patients, 88.5%) and stent (14 patients, 53.8%) were also used to complete the treatment. Two patients in interventional group needed a second intervention due to a recurrent thrombosis in the postoperative 3rd day. Prophylactic IVC filters were placed in 2 patients. Post interventional thrombosis clearance rates were controlled by venography. In both groups pretreatment Doppler US and clinical symptom scoring were compared with post treatment first and third month controls.The results showed a 88.4% successful recanalization in the post treatment venography in the interventional group. Venous patency rates in post treatment third month Doppler US controls were 91.7% in the interventional group and 28.6% in the medical group. When the clinical symptom scorings were compared there was a significant improvement in the interventional group (4,23±0,51 pretreatment; 0,82±0,79 post treatment third month) whereas there was no significant change in the clinical symptoms in the medical group (4,00±0,63 pretreatment; 2,86±0,79 post treatment third month). During follow up 1 patient had pulmonary embolism, which was not related with the technique, and there was symptomatic pulmonary embolism in 4 patients in the control group.Anticoagulation does not have a lytic effect on the thrombus in iliofemoral-popliteal DVT and it does not prevent effectively the extension of the thrombosis. Percutaneous aspiration thrombectomy is more efficient in achieving venous patency and in the prevention of the complications of the DVT. Furthermore, it is technique which is cheaper, easier to learn and to apply and faster than other endovascular techniques and it minimalizes the hemorrhagic complication risk.The results of this study suggest that PAT can be used as the first line treatment in the proximal acute DVT and especially in cases, which have a contraindication for thrombolytic agents.