# Midterm clinical outcomes of mechanical versus rheolytic thrombectomy for iliofemoral or iliocaval deep vein thrombosis

## TL;DR

The study compares mechanical and rheolytic thrombectomy for deep vein thrombosis, finding both methods effective but mechanical thrombectomy reduces thrombolysis and stent use.

## Contribution

This study provides new comparative clinical evidence on mechanical versus rheolytic thrombectomy for iliofemoral DVT.

## Key findings

- Mechanical thrombectomy reduced thrombolytic use and stent placement compared to rheolytic thrombectomy.
- Both methods achieved high patency rates and freedom from post-thrombotic syndrome.
- Popliteal vein thrombosis occurred in 13% of mechanical thrombectomy patients but none in rheolytic thrombectomy patients.

## Abstract

In patients with iliofemoral deep vein thrombosis (DVT), early thrombus removal reduces the risk of post-thrombotic syndrome (PTS). It remains uncertain if mechanical thrombectomy (MT) using the ClotTriever system may offer advantages as compared with rheolytic thrombectomy (RT) using the AngioJet ZelanteDVT.

In our multicenter, retrospective, observational study, we included 122 patients (mean age, 48 years; 57% women) with iliofemoral (78%) or iliocaval DVT (22%). All underwent early thrombus removal with either MT (n = 40) or RT (n = 82) and had a minimum of 3 months of follow-up. Periprocedural outcomes included periprocedural thrombolytic use, access complications, and stent placement rate. Clinical outcomes included stent patency rate and freedom from PTS.

The median follow-up was 25 months (interquartile range, 11-52 months). Compared with RT, MT was associated with lower periprocedural thrombolytic use (38% vs 95%; P < .01) and a lower rate of stent placement (70% vs 98%; P < .01). Postprocedural access site thrombosis of the popliteal vein occurred in 5 MT patients (13%) and in none of the RT patients. At 1 year, primary and secondary patency rates were 80% (95% confidence interval [CI], 67%-95%) and 97% (95% CI, 93%-100%) in the MT group, and 88% (95% CI, 81%-96%) and 97% (95% CI, 94%-100%) in the RT group, respectively. Freedom from PTS at latest follow-up was observed in 98% of the MT group (95% CI, 93%-100%) and 94% of RT patients (95% CI, 87%-100%).

Both MT and RT were associated with high patency rates and freedom from PTS. MT may decrease the need for thrombolysis and venous stent placement. Popliteal vein thrombosis from large-bore access in MT patients requires further investigation.