Published online Jan 26, 2023. doi: 10.12998/wjcc.v11.i3.598
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
Filter-related thrombosis is a complication of filter implantation. Early thrombus removal is implemented to restore the patency of the caval outflow. AngioJet rheolytic thrombectomy (ART) and catheter-directed thrombolysis (CDT) are endovascular treatment methods for filter-related caval thrombosis, but the clinical outcomes of both treatment modalities have not been determined.
We have performed both CDT and ART for filter-related thrombosis at our center. To date, there are few studies comparing the clinical outcomes of the two surgical methods, and the results are expected to be reported.
The aim of this study is to compare the clinical outcomes of AngioJet rheolytic thrombectomy with those of catheter-directed thrombolysis in patients with filter-related caval thrombosis.
Sixty-five 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. Of these, patients were divided into the AngioJet group (n = 44) and 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.
There was no significant difference in thrombus clearance between the two groups (P > 0.05). The peridiameter difference of the thigh was significantly reduced in the patients of both groups after treatment (P < 0.05). The median dosage of urokinase was significantly lower in the ART group (0.08 (0.02, 0.25) million U) than in the CDT group (1.50 (1.17, 1.83) million U) (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). There was no case of symptomatic PE after the procedure in either group. The mean length of stay was 11.67 ± 5.34 d in the CDT group and 10.64 ± 3.52 d 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 AngioJet group (P > 0.05).
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.
Further large, prospective clinical studies of the clinical outcomes of CDT and ART are needed.