Novel mechanical thrombectomy techniques for upper-extremity DVT
Affiliations: Clinic of Vascular and Endovascular Surgery, Athens Medical Center, Greece
Upper extremity deep vein thrombosis (UEDVT) has been traditionally managed with anticoagulation and in selected active symptomatic patients with catheter-directed thrombolysis (CDT) targeting prompt venous recanalization towards a subsequent rib resection when venous compression is identified. CDT requires prolonged dripping, intensive care unit (ICU) stay, and carries a risk of bleeding while more chronic material may not be lysed. Novel mechanical thrombectomy devices can potentially simplify the safety, the efficacy, and the logistics of the procedure.
Three young patients with symptomatic UEDVT underwent percutaneous mechanical thrombectomy utilizing 3 different devices, the ClotTriever system (Inari Medical, Irvine, CA), the Aspirex Mechanical Aspiration Thrombectomy System and the Penumbra System (Penumbra Inc, Alameda, California, USA). The technical results and clinical outcomes were reviewed.
Percutaneous thrombectomy through basilic vein access was performed and successfully completed in all 3 patients with greater than 90% thrombus resolution. Low-dose local on-table thrombolytics were used to address thrombi in the collateral vessels. Balloon venoplasty was performed at the area of compression when identified. No major adverse events were noted, and patients were discharged within 24 hours. Two out of the 3 patients underwent subsequent first rib resection. Additional venous stent reconstruction was not required. At 2-year follow up, all patients had resumed full athletic activity without UEDVT recurrence.
For the management of symptomatic UEDVT, mechanical thrombectomy using novel technologies is feasible with excellent technical and clinical success.
