L. Loss1, S. Stefanopoulos1, A. Siddiq1, S. Markowiak1, W. Qu1, M. F. Osman1, J. Ortiz1, F. C. Brunicardi1, M. Nazzal1 1University Of Toledo Medical Center,Department Of Surgery,Toledo, OH, USA
Introduction:
The optimum treatment of deep vein thrombosis (DVT) remains elusive and practice guidelines continue to evolve. For acute, extensive, proximal DVT, there is currently little consensus on the role of thrombectomy compared to catheter directed lysis (CDL). We sought to determine whether any differences in outcomes exist between thrombectomy and CDL in terms of postoperative venous patency, recurrence rate, pulmonary embolism (PE), and bleeding/hematoma.
Methods:
An IRB approved, retrospective cohort study was performed at a single academic medical center for patients with radiographically confirmed lower extremity DVT during the period of 2012-2015. The patients were divided into thrombectomy and CDL cohorts. The thrombectomy cohort included patients treated with Angiojet™, Pulse Spray Angiojet™, or Trellis Infusion Catheter™. Demographic information, comorbidities and laboratory data, postoperative patency, postoperative bleeding, postoperative pulmonary embolism, popliteal hematoma, and recurrence of DVT were collected. X2 tests were used with p value set at 0.05.
Results:
35 patients were identified, 54.2% (n=19) received CDL (31.6% female (n=6), average age 58.6 years, median age 64 years) and 46% (n=16) underwent thrombectomy (37.5% female (n=6), average age 46 years). Patient comorbidities and hypercoagulable states were not significantly different among the groups (Table 1). The two groups had the same indications for treatment as they did not differ significantly in terms of their presenting symptoms (Table 1).
The two techniques did not have significantly different postoperative patency (p=0.871), bleeding (p=0.863), PE (p=0.930), popliteal hematoma (0.367), or recurrence of DVT (p=0.849, Table 1). 5.3% (n=1) of CDL patients had postoperative compartment syndrome while no thrombectomy patients had this complication. 6.7% (n=1) of thrombectomy patients had postoperative hematuria while no CDL patients had this complication. 63.2% (n=12) of CDL patients had no postoperative complications and 60% (n=9) of thrombectomy patients had no postoperative complications (p=0.927, Table 1). This study was powered to detect a 33% difference in outcome based on a p-value of 0.05 and power of 0.80.
Conclusions:
In selecting optimum treatment for acute, extensive, proximal DVT our retrospective cohort study found no significant differences among treatment groups in safety, efficacy, recurrence, and progression to PE. We conclude that modality of treatment should be decided upon based on hospital resources, surgeon experience and comfort with each technique, and the patient’s physiologic status.
