Endovascular treatment of acute and subacute iliofemoral deep venous thrombosis by using manual aspiration thrombectomy: long-term results of 139 patients in a single center.

PURPOSE To evaluate the immediate and long-term outcomes of percutaneous manual aspiration thrombectomy with provisional stent placement in treating acute and subacute iliofemoral deep venous thrombosis (DVT). MATERIALS AND METHODS One hundred and thirty-nine consecutive patients (75 women; mean age, 51 years) with acute (n=110) or subacute (n=29) iliofemoral DVT underwent endovascular treatment (total of 148 limbs). All patients were treated with percutaneous manual aspiration thrombectomy by using large-bore guiding catheters with adjunctive catheter-directed thrombolysis and stent placement, if needed. Venography was used to grade thrombus removal. RESULTS Thrombus removal was less than 50% in five limbs (3.4%), between 50% and 95% in 45 limbs (30.4%), and more than 95% in 98 limbs (66.2%). At least one stent was placed in 99 limbs. Recurrent thrombosis occurred in 27 patients, mostly during the first few months after the procedure. Rethromboses were more frequent among postpartum patients. One patient had a major pulmonary embolism. No major hemorrhage or procedure-related deaths occurred. CONCLUSION Manual aspiration thrombectomy is a safe, rapid, and effective treatment option for acute and subacute iliofemoral DVT. Hence, catheter-directed thrombolysis may not be required in a majority of patients.