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      Mechanical Venous Thrombectomy for Deep Venous Thrombosis in Cancer Patients: A Single-Center Retrospective Study

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          Abstract

          Purpose

          Venous thromboembolism (VTE) is a major contributor to the mortality of cancer patients. Mechanical thrombectomy (MT) is an endovascular technique that physically removes a thrombus without thrombolytics. The purpose of this study was to evaluate safety, efficacy, and clinical outcomes following MT for lower extremity DVT in cancer patients.

          Methods

          This single-center, retrospective study evaluated outcomes following MT of lower extremity DVT in cancer patients from November 2019 to May 2023. The primary outcome measure was clinical success, defined as a decrease in Villalta score by at least 2 points following the intervention. Secondary outcomes included repeat intervention-free survival and overall survival. Technical success was defined as restoring venous flow with mild (< 10%) or no residual filling defect.

          Results

          In total, 90 patients and 113 procedures were included. Technical and clinical success was achieved in 81% and 87% of procedures performed. Repeat intervention-free survival at 1 month, 3 months, and 6 months post-procedure was 92%, 82%, and 77%, respectively. The complication rate was 2.7%. Pathologic analysis of the extracted thrombus revealed tumor thrombus in 18.4% (18/98) samples. Overall survival for the study cohort was 87% at 1 month, 74% at 3 months, and 62% at 6 months. Patients who were found to have tumor thrombi were noted to have a decreased overall survival compared to patients with non-tumor thrombi ( P = 0.012).

          Conclusion

          MT is safe and efficacious in reducing cancer patients’ VTE-related symptoms. The high rate of tumor thrombus in thrombectomy specimens suggests this phenomenon is more common than suspected.

          Graphical Abstract

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00270-024-03691-3.

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          Most cited references18

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          Development and validation of a predictive model for chemotherapy-associated thrombosis.

          Alok A. Khorana, Nicole M Kuderer, Eva Culakova … (2008)
          Risk of venous thromboembolism (VTE) is elevated in cancer, but individual risk factors cannot identify a sufficiently high-risk group of outpatients for thromboprophylaxis. We developed a simple model for predicting chemotherapy-associated VTE using baseline clinical and laboratory variables. The association of VTE with multiple variables was characterized in a derivation cohort of 2701 cancer outpatients from a prospective observational study. A risk model was derived and validated in an independent cohort of 1365 patients from the same study. Five predictive variables were identified in a multivariate model: site of cancer (2 points for very high-risk site, 1 point for high-risk site), platelet count of 350 x 10(9)/L or more, hemoglobin less than 100 g/L (10 g/dL) and/or use of erythropoiesis-stimulating agents, leukocyte count more than 11 x 10(9)/L, and body mass index of 35 kg/m(2) or more (1 point each). Rates of VTE in the derivation and validation cohorts, respectively, were 0.8% and 0.3% in low-risk (score = 0), 1.8% and 2% in intermediate-risk (score = 1-2), and 7.1% and 6.7% in high-risk (score >/= 3) category over a median of 2.5 months (C-statistic = 0.7 for both cohorts). This model can identify patients with a nearly 7% short-term risk of symptomatic VTE and may be used to select cancer outpatients for studies of thromboprophylaxis.
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            Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial.

            Tone Enden, Ylva Haig, Nils-Einar Kløw … (2012)
            Conventional anticoagulant treatment for acute deep vein thrombosis (DVT) effectively prevents thrombus extension and recurrence, but does not dissolve the clot, and many patients develop post-thrombotic syndrome (PTS). We aimed to examine whether additional treatment with catheter-directed thrombolysis (CDT) using alteplase reduced development of PTS. Participants in this open-label, randomised controlled trial were recruited from 20 hospitals in the Norwegian southeastern health region. Patients aged 18-75 years with a first-time iliofemoral DVT were included within 21 days from symptom onset. Patients were randomly assigned (1:1) by picking lowest number of sealed envelopes to conventional treatment alone or additional CDT. Randomisation was stratified for involvement of the pelvic veins with blocks of six. We assessed two co-primary outcomes: frequency of PTS as assessed by Villalta score at 24 months, and iliofemoral patency after 6 months. Analyses were by intention to treat. This trial is registered at ClinicalTrials.gov, NCT00251771. 209 patients were randomly assigned to treatment groups (108 control, 101 CDT). At completion of 24 months' follow-up, data for clinical status were available for 189 patients (90%; 99 control, 90 CDT). At 24 months, 37 (41·1%, 95% CI 31·5-51·4) patients allocated additional CDT presented with PTS compared with 55 (55·6%, 95% CI 45·7-65·0) in the control group (p=0·047). The difference in PTS corresponds to an absolute risk reduction of 14·4% (95% CI 0·2-27·9), and the number needed to treat was 7 (95% CI 4-502). Iliofemoral patency after 6 months was reported in 58 patients (65·9%, 95% CI 55·5-75·0) on CDT versus 45 (47·4%, 37·6-57·3) on control (p=0·012). 20 bleeding complications related to CDT included three major and five clinically relevant bleeds. Additional CDT should be considered in patients with a high proximal DVT and low risk of bleeding. South-Eastern Norway Regional Health Authority; Research Council of Norway; University of Oslo; Oslo University Hospital. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis

              David J. Cohen, Michael R Jaff, Susan R. Kahn … (2017)
              The post-thrombotic syndrome frequently develops in patients with proximal deep-vein thrombosis despite treatment with anticoagulant therapy. Pharmacomechanical catheter-directed thrombolysis (hereafter "pharmacomechanical thrombolysis") rapidly removes thrombus and is hypothesized to reduce the risk of the post-thrombotic syndrome.
              Article 0 comments Cited 143 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Rahul A. Sheth:
                ORCID: http://orcid.org/0000-0001-9615-8985
                rasheth@mdanderson.org
                Journal
                Journal ID (nlm-ta): Cardiovasc Intervent Radiol
                Journal ID (iso-abbrev): Cardiovasc Intervent Radiol
                Title: Cardiovascular and Interventional Radiology
                Publisher: Springer US (New York )
                ISSN (Print): 0174-1551
                ISSN (Electronic): 1432-086X
                Publication date (Electronic): 28 March 2024
                Publication date PMC-release: 28 March 2024
                Publication date (Print): 2024
                Volume: 47
                Issue: 5
                Pages: 556-566
                Affiliations
                [1 ]Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, ( https://ror.org/04twxam07) 1515 Holcombe Blvd., Unit 1471, Houston, TX 77030-4009 USA
                [2 ]Section of Benign Hematology, University of Texas MD Anderson Cancer Center, ( https://ror.org/04twxam07) Houston, TX USA
                Author information
                http://orcid.org/0000-0001-9615-8985
                Article
                Publisher ID: 3691
                DOI: 10.1007/s00270-024-03691-3
                PMC ID: 11074016
                PubMed ID: 38548981
                SO-VID: ba05b56d-63d3-42df-a127-422a3d7181a6
                Copyright © © The Author(s) 2024
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 11 November 2023
                Date accepted : 20 February 2024
                Categories
                Subject: Clinical Investigation
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2024

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: venous thromboembolism,mechanical thrombectomy,cancer,endovascular
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: venous thromboembolism, mechanical thrombectomy, cancer, endovascular

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