A systematic review of percutaneous mechanical thrombectomy in the treatment of deep venous thrombosis.

BACKGROUND In selected cases of deep vein thrombosis (DVT), catheter-directed thrombolysis (CDT) may be superior to conventional treatment with anticoagulation alone, as it can prevent DVT recurrence and the development of post-thrombotic syndrome (PTS). Percutaneous mechanical thrombectomy (PMT) devices offer a minimally invasive adjunctive strategy and the data on these emerging technologies require review. OBJECTIVES To review the evidence for PMT devices in DVT in terms of case selection, technical feasibility and procedural outcomes. METHODS Medline, trial registries, conference proceedings and article reference lists were searched to identify case series reporting PMT device use. Data were extracted for review. RESULTS 16 retrospective case series have reported the use of rheolytic, rotational, or ultrasound-assisted PMT in a total of 481 patients. No randomised trials were available. Technical success of 82-100% was reported with Grade II or III lysis in 83-100% of patients. The different devices all appeared to be safe, with no reported procedure-related deaths or strokes and <1% incidence of symptomatic PE. Bleeding complications were reported in 6/16 studies, in which 4-14% of patients required transfusion (global incidence 11/146 patients, 7.5%). CONCLUSION PMT appears feasible and safe, though the level of evidence available is poor. Major RCTs and registry data are required to determine the economic and clinical benefit of various devices used alone or in combination, for differing thrombus characteristics and clinical scenarios. Until these data are available there is little substantial evidence to support the routine use of PMT over CDT alone.