Outcomes from a tertiary care center using a catheter thrombectomy system for managing acute iliofemoral deep vein thrombosis.

OBJECTIVE: The aim of the present study was to report a large, single-center experience using the ClotTriever thrombectomy system (Inari Medical, Irvine, CA) for the management of acute iliofemoral (IF) deep vein thrombosis (DVT). One limitation of all endovascular devices for the treatment of acute IF-DVT has been the inability to completely remove all acute thrombus and the need for adjunctive thrombolysis with its attendant risk of bleeding complications. METHODS: A single-center retrospective review of consecutive patients with acute IF-DVT treated with the ClotTriever thrombectomy system (Inari Medical) is reported. Procedural efficacy was evaluated by an independent core imaging laboratory (Syntactx, New York, NY). Both procedural and in-hospital safety were assessed during the index hospitalization. The treated vein patency was assessed using duplex ultrasound at 30 days after the procedure. RESULTS: A total of 96 patients were included in the present retrospective review, 40 of whom (40%) had contraindications to thrombolytic therapy. In terms of efficacy, 93 patients (97%) had ≥75% thrombus removal. During the index hospitalization, two patients (2%) had experienced a symptomatic pulmonary embolus. However, no mortality, major bleeding, or device-related complications had occurred in the study population. Of the 96 patients, 64 had undergone duplex ultrasound at 30 days after the procedure. Of the 64 patients, 62 had normal flow (97%), 53 (83%) had normal compressibility, and 11 (17%) had partial compressibility. CONCLUSIONS: The ClotTriever thrombectomy catheter was both safe and effective in our cohort of patients with acute IF-DVT outside a randomized clinical trial.

Treatment of acute limb ischemia with a percutaneous mechanical thrombectomy-based endovascular approach: 5-year limb salvage and survival results from a single center series.

OBJECTIVES: The study evaluated long-term limb salvage and survival of an endovascular approach that incorporates mechanical thrombectomy (PMT) in the management of arterial thrombosis. BACKGROUND: Acute limb ischemia is associated with a high risk of amputation and death. Previous reports from the United States (U.S.) of surgical and nonsurgical treatments are limited to primarily 30 days to 1 year. METHODS: Single-center, retrospective review of 57 consecutive patients (30 male, 27 female; mean age 63.8 +/- 13.8 years) treated for limb threatening ischemia due to thrombotic arterial occlusions. Data includes baseline assessments, procedural outcomes, in-hospital complications, 30-day, and long-term follow-up. RESULTS: Ninety-three percent of patients (n = 53) presented with onset of symptoms (<14 days). Angiography following PMT showed thrombus removal complete/substantial 36 (63.6%), partial 16 (28.0%), and minimal 5 (8.8%), respectively. Catheter-directed thrombolysis was used after PMT in 18 patients (31.6%). In-hospital success with limb salvage was attained in 96.5% (n = 55) with mortality of 3.5% (n = 2). Thirty-day limb salvage and mortality were 94.7% (n = 54) and 5.3% (n = 3), respectively. At mean 5-year follow-up (mean = 62 months), three patients have been lost to follow-up. The results of 54/57 (94.7%) are available. Amputation free survival was 94.7% (n = 36/38) with long-term mortality rate of 29.6% (n = 16/54). CONCLUSIONS: Acute limb ischemia treated with PMT alone or in combination with thrombolysis, followed by definitive therapy, results in favorable long-term limb salvage. Allowing for appreciable long-term mortality in vascular patients, survivors demonstrate amputation-free success from the initial endovascular procedure with low reintervention rate.

The role of radiation therapy in the treatment of femoropopliteal occlusive disease.

With the success of brachytherapy in the coronary vessels as a guide, it has also shown promising initial results as an adjunct for the treatment and prevention of restenosis of femoropopliteal occlusive disease. With the rapid evolution of endovascular therapy, defining the role of brachytherapy will become even more important. The purpose of this review is to provide an overview of the role of brachytherapy in the treatment of restenosis following femoropopliteal endovascular intervention.

Use of glycoprotein IIb/IIIa platelet inhibitors in peripheral vascular interventions.

With the expanding use of endovascular techniques for the treatment of peripheral vascular disease, consideration of glycoprotein IIb/IIIa receptor inhibitors to enhance the safety and efficacy of these procedures has increased. The scientific literature shows the benefits with the use of these agents in coronary vasculature interventions. However, data evaluating treatment with glycoprotein IIb/IIIa receptor inhibitors during peripheral vascular procedures is limited, with the vast majority of the trials investigating abciximab. With the varied vascular beds and end organs that may be affected by peripheral vascular intervention, the safety and efficacy may need to be studies for each area. The current literature ranging from carotid stenting to thrombolysis and mechanical thrombectomy for acute limb ischemia is reviewed, and recommendations are discussed on the use of these agents. The forthcoming results of controlled clinical trials should further clarify the clinical applications of these agents in peripheral vascular intervention.