Key finding

Thrombus removal of early proximal deep vein thrombosis using a pharmacomechanical thrombectomy catheter (AngioJet) improved symptoms and quality of life; however, at 1 year, no persistent advantages were found, including the incidence of post-thrombotic syndrome (PTS).

Study summary

This was a subset analysis of the ATTRACT (acute venous thrombosis: thrombus removal with adjunctive catheter-directed thrombolysis) trial (multicenter, randomized, prospective) considering the patients who had undergone thrombectomy with an AngioJet compared with anticoagulation alone. At the 33 clinical sites, 173 patients were included from facilities that had incorporated the AngioJet into their thrombectomy protocol. Of these 173 patients, 75 had actually had the AngioJet used. The data analyzed included all patients randomized to a site that had incorporated the Angiojet regardless of whether the device was used. A second analysis was performed to examine those who had actually had the AngioJet device used. Both the aggregate group and the AngioJet group had similar outcomes. Of the 75 patients, 40% had developed PTS, with 12% developing moderate to severe PTS within 2 years, similar to the control arm. No differences were found in any of the quality of life scores. At 24 months, the incidence of venous thromboembolism (VTE) was 13.9% in the AngioJet group vs 6.8% in the control group (P < .5).

Commentary

This subset analysis of patients enrolled in the ATTRACT trial who had had deep vein thrombosis and had undergone thrombus removal with an AngioJet showed similar results to the main study, which had included any type of pharmacomechanical device. The AngioJet mechanical thrombectomy device has been available for >15 years, with much data in existence. The catheters have evolved over time to include the addition of thrombolytic agents in catheters with stronger rheolytic capability. It is clear that the device effectively removes thrombus. However, what has been largely unknown is the effects on the delicate venous endothelium. In this study, AngioJet patients had twice the risk of VTE recurrence. Were these patients predisposed to recurrent VTE from the type of thrombus (location, extent) or had additional endothelial damage occurred above and beyond the original thrombus? This study has, by no means, answered this question but has provided further evidence toward the lack of long-term advantages of pharmacomechanical devices.

Article InfoPublication HistoryJ Vasc Interv Radiol 2021;32:1296-1309.e7.Identification

DOI: https://doi.org/10.1016/j.jvsv.2022.04.002

Copyright

© 2022 Published by Elsevier Inc.

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