Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2023; 11(3): 598-609
Published online Jan 26, 2023. doi: 10.12998/wjcc.v11.i3.598
Clinical outcomes of AngioJet pharmacomechanical thrombectomy versus catheter-directed thrombolysis for the treatment of filter-related caval thrombosis
Jin-Yong Li, Jian-Long Liu, Xuan Tian, Wei Jia, Peng Jiang, Zhi-Yuan Cheng, Yun-Xin Zhang, Xiao Liu, Mi Zhou
Jin-Yong Li, Jian-Long Liu, Xuan Tian, Wei Jia, Peng Jiang, Zhi-Yuan Cheng, Yun-Xin Zhang, Xiao Liu, Mi Zhou, Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
Author contributions: All listed authors have read and approved the final draft of the manuscript; Tian X, and Liu JL contributed to the conception of the research idea and critical revision of the manuscript; Zhou M and Liu X contributed to the data collection and initial draft; Cheng ZY contributed to statistical analysis, critical revision, and final draft of the manuscript; Li JY wrote the manuscript; Jiang P, Jia W, and Zhang YX reviewed and edited the manuscript.
Supported by Beijing Municipal Administration of Hospital Incubating Program, No, PX2022015.
Institutional review board statement: This study secured ethical approval from the Ethics Committee of Beijing Jishuitan Hospital.
Informed consent statement: All study participants provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xuan Tian, Doctor, Associate Professor, Department of Vascular Surgery, Beijing Jishuitan Hospital, No. 31 East Street, Xinjiekou, Xicheng District, Beijing 100035, China. doctor_tx@sina.com
Received: October 30, 2022
Peer-review started: October 30, 2022
First decision: December 13, 2022
Revised: December 22, 2022
Accepted: January 5, 2023
Article in press: January 5, 2023
Published online: January 26, 2023
Processing time: 87 Days and 23.6 Hours
Abstract
BACKGROUND

The inferior vena cava filter is utilized worldwide to intercept thrombi and to reduce the risk of fatal pulmonary embolism (PE). However, filter-related thrombosis is a complication of filter implantation. Endovascular methods such as AngioJet rheolytic thrombectomy (ART) and catheter-directed thrombolysis (CDT) can treat filter-related caval thrombosis, but the clinical outcomes of both treatment modalities have not been determined.

AIM

To compare the treatment outcomes of AngioJet rheolytic thrombectomy vs catheter-directed thrombolysis in patients with filter-related caval thrombosis.

METHODS

In this single-center retrospective study, 65 patients (34 males and 31 females; mean age: 59.0 ± 13.43 years) with intrafilter and inferior vena cava thrombosis were enrolled between January 2021 and August 2022. These patients were assigned to either the AngioJet group (n = 44) or the CDT group (n = 21). Clinical data and imaging information were collected. Evaluation measures included thrombus clearance rate, periprocedural complications, urokinase dosage, incidence of PE, limb circumference difference, length of stay, and filter removal rate.

RESULTS

Technical success rates were 100% in the AngioJet and CDT groups. In the AngioJet group, grade II and grade III thrombus clearance was achieved in 26 (59.09%) and 14 (31.82%) patients, respectively. In the CDT group, grade II and grade III thrombus clearance was accomplished in 11 (52.38%) patients and 8 (38.10%) patients, respectively (P > 0.05).The peridiameter difference of the thigh was significantly reduced in patients from both groups after treatment (P < 0.05). The median dosage of urokinase was 0.08 (0.02, 0.25) million U in the AngioJet group and 1.50 (1.17, 1.83) million U in the CDT group (P < 0.05). Minor bleeding was shown in 4 (19.05%) patients in the CDT group, and when it was compared with that in the AngioJet group, the difference was statistically significant (P < 0.05). No major bleeding occurred. Seven (15.91%) patients in the AngioJet group had hemoglobinuria and 1 (4.76%) patient in the CDT group had bacteremia. There were 8 (18.18%) patients with PE in the AngioJet group and 4 (19.05%) patients in the CDT group before the intervention (P > 0.05). Computed tomography angiopulmonography (CTA) showed that PE was resolved after the intervention. New PE occurred in 4 (9.09%) patients in the AngioJet group and in 2 (9.52%) patients in the CDT group after theintervention (P > 0.05). These cases of PE were asymptomatic. The mean length of stay was longer in the CDT group (11.67 ± 5.34 d) than in the AngioJet group (10.64 ± 3.52 d) (P < 0.05). The filter was successfully retrieved in the first phase in 10 (47.62%) patients in the CDT group and in 15 (34.09%) patients in the AngioJet group (P > 0.05).Cumulative removal was accomplished in 17 (80.95%) out of 21 patients in the CDT group and in 42 (95.45%) out of 44 patients in the ART group (P > 0.05). The median indwelling time for patients with successful retrieval was 16 (13139) d in the CDT group and 59 (12231) d in the ART group (P > 0.05).

CONCLUSION

Compared with catheter-directed thrombolysis, AngioJet rheolytic thrombectomy can achieve similar thrombus clearance effects, improve the filter retrieval rate, reduce the urokinase dosage and lower the risk of bleeding events in patients with filter-related caval thrombosis.

Keywords: Inferior vena cava filter; Thrombosis; AngioJet rheolytic thrombectomy; Catheter-directed thrombolysis; Clinical outcome

Core Tip: This is a retrospective study. A total of 65 patients were enrolled to evaluate the clinical outcomes of different treatment methods in patients with filter-related caval thrombosis. We compared the data of patients between the AngioJet rheolytic thrombectomy group (n = 44) and the catheter-directed thrombolysis group (n = 21). The current results showed no difference in thrombus clearance or filter retrieval rate. However, the results showed significant differences in urokinase dosage, peridiameter difference of the thigh, minor bleeding, and length of stay.