Effectiveness and safety of catheter-directed thrombolysis in conjunction with percutaneous mechanical thrombectomy for acute iliofemoral deep vein thrombosis: A meta-analysis

Weihao Li; Abdallah Zaid Al-Kaylani; Clark J Zeebregts; Mostafa El Moumni; Jean-Paul P M de Vries; Hubert P J van der Doef; Reinoud P H Bokkers

doi:10.1016/j.jvsv.2023.01.010

Effectiveness and safety of catheter-directed thrombolysis in conjunction with percutaneous mechanical thrombectomy for acute iliofemoral deep vein thrombosis: A meta-analysis

J Vasc Surg Venous Lymphat Disord. 2023 Jul;11(4):843-853.e2. doi: 10.1016/j.jvsv.2023.01.010. Epub 2023 Mar 7.

Authors

Weihao Li¹, Abdallah Zaid Al-Kaylani², Clark J Zeebregts³, Mostafa El Moumni³, Jean-Paul P M de Vries³, Hubert P J van der Doef⁴, Reinoud P H Bokkers⁵

Affiliations

¹ Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
² Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
³ Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁴ Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁵ Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Electronic address: r.p.h.bokkers@umcg.nl.

PMID: 36893883
DOI: 10.1016/j.jvsv.2023.01.010

Abstract

Background: Patients with severe acute low iliofemoral deep vein thrombosis (DVT), such as phlegmasia cerulea dolens, benefit from catheter-directed thrombolysis (CDT). This meta-analysis investigated the effectiveness and safety of adjuvant percutaneous mechanical thrombectomy (PMT) during CDT compared with CDT alone in the treatment of acute iliofemoral DVT.

Methods: A meta-analysis was performed in accordance with the PRISMA guidelines. Medline, Embase, the Cochrane Library, China National Knowledge Internet, and Wanfang data were searched for studies on the management of acute iliofemoral DVT by means of CDT or CDT with adjuvant PMT. Randomized, controlled trials and nonrandomized studies were included. The primary outcomes were venous patency rate, major bleeding complications, and post-thrombotic syndrome occurrence within 2 years of the procedure. The secondary outcomes were thrombolytic time and volume, as well as the rates of thigh detumescence and iliac vein stenting.

Results: The meta-analysis included 20 eligible studies with a total of 1686 patients. The rates of venous patency (mean difference, 10.11; 95% confidence interval [CI], 5.59-14.62) and thigh detumescence (mean difference, 3.64; 95% CI, 1.10-6.18) of the adjuvant PMT group were higher than those of the CDT alone group. Compared with CDT alone, the adjuvant PMT group experienced fewer incidences of major bleeding complications (odds ratio, 0.45; 95% CI, 0.26-0.77) and occurrences of post-thrombotic syndrome within 2 years of the procedure (odds ratio, 0.55; 95% CI, 0.33-0.92). Furthermore, the duration of thrombolytic therapy was shorter, and the total dose of administered thrombolytics was lower with adjuvant PMT.

Conclusions: Adjuvant PMT during CDT is associated with improved clinical outcomes and a lower incidence of major bleeding complications. The studies investigated were, however, single-center cohort studies, and future randomized controlled trials are needed to substantiate these findings.

Keywords: Deep vein thrombosis; Lower extremity; Meta-analysis; Thrombectomy; Thrombolysis.

Publication types

Meta-Analysis
Review

MeSH terms

Catheters / adverse effects
Fibrinolytic Agents
Hemorrhage / complications
Humans
Iliac Vein / diagnostic imaging
Mechanical Thrombolysis* / adverse effects
Postthrombotic Syndrome* / diagnostic imaging
Postthrombotic Syndrome* / etiology
Postthrombotic Syndrome* / therapy
Retrospective Studies
Thrombectomy / adverse effects
Thrombectomy / methods
Thrombolytic Therapy / adverse effects
Thrombolytic Therapy / methods
Treatment Outcome
Venous Thrombosis* / complications
Venous Thrombosis* / diagnostic imaging
Venous Thrombosis* / therapy

Substances

Fibrinolytic Agents