Effectiveness and safety of catheter-directed thrombolysis in conjunction with percutaneous mechanical thrombectomy for acute iliofemoral deep vein thrombosis: a meta-analysis

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BACKGROUND: Patients with severe acute low iliofemoral deep vein thrombosis (DVT), such as phlegmasia cerulea dolens, benefit from catheter-directed thrombolysis (CDT). This meta-analysis investigated the effectiveness and safety of adjuvant percutaneous mechanical thrombectomy (PMT) during CDT compared with CDT alone in the treatment of acute iliofemoral DVT.

METHODS: A meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Embase, the Cochrane Library, China National Knowledge Internet and Wanfang data were searched for studies on the management of acute iliofemoral DVT by means of CDT or CDT with adjuvant PMT. Randomized controlled trials and nonrandomized studies were included. The primary outcomes were venous patency rate, major bleeding complications, and post-thrombotic syndrome occurrence within 2 years of the procedure. The secondary outcomes were thrombolytic time and volume, and the rates of thigh detumescence and iliac vein stenting.

RESULTS: The meta-analysis included 20 eligible studies with a total of 1686 patients. The rates of venous patency (MD 10.11; 95% CI 5.59 - 14.62) and thigh detumescence (MD 3.64; 95% CI 1.10 - 6.18) of the adjuvant PMT group were higher than those of the CDT alone group. Compared with CDT alone, the adjuvant PMT group experienced fewer incidences of major bleeding complications (OR 0.45; 95% 0.26 - 0.77) and occurrences of post-thrombotic syndrome within 2 years of the procedure (OR 0.55; 95% CI 0.33 - 0.92). Furthermore, the duration of thrombolytic therapy was shorter, and the total dose of administered thrombolytics was reduced with adjuvant PMT.

CONCLUSIONS: Adjuvant PMT during CDT is associated with improved clinical outcomes and a lower incidence of major bleeding complications. The studies investigated were, however, single-center cohort studies, and future randomized controlled trials are needed to substantiate these findings.

Original languageEnglish
Pages (from-to)P843-853.E2
Number of pages13
JournalJournal of Vascular Surgery: Venous and Lymphatic Disorders
Issue number4
Early online date7-Mar-2023
Publication statusPublished - Jul-2023

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