Wenda Wang1, Rui Sun1, Yuexin Chen2, Changwei Liu1. 1. Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. 2. Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. Electronic address: cyuexin2007@163.com.
Abstract
OBJECTIVE: The objective of this review was to evaluate the efficacy and safety of percutaneous mechanical thrombectomy (PMT) with or without catheter-directed thrombolysis (CDT) in the treatment of lower extremity deep venous thrombosis (DVT). METHODS: We searched PubMed for clinical trials and prospective or retrospective case series (comparative or single-arm studies) that focused on PMT ± CDT in the treatment of DVT, published before March 2, 2017. We meta-analyzed perioperative outcomes and complications and long-term outcomes of this procedure. We also compared the results between PMT ± CDT and CDT alone, using the data from comparative studies. RESULTS: Overall, 1323 PMT ± CDT patients from 35 studies were included in our study. The rate of patients experiencing successful thrombolysis with a partial or complete lysis rate was 93.4% (95% confidence interval [CI], 90.1%-95.6%) or 67.0% (95% CI, 59.1%-76.4%), respectively. The pooled proportion of 30-day rethrombosis rate was 11.9% (95% CI, 6.7%-20.3%). The 30-day DVT-related mortality was 2.4% (95% CI, 1.6%-3.7%). The perioperative incidence of major bleeding and pulmonary embolism was 4.6% (95% CI, 2.9%-7.3%) and 3.8% (95% CI, 2.5%-6.7%), respectively. During the follow-up, the late rethrombosis rate was 10.7% (95% CI, 8.7%-13.0%; the average follow-up period ranged from 2.8 to 32.1 months). About 15.1% (95% CI, 9.6%-22.9%) of patients developed post-thrombotic syndrome during follow-up (the average follow-up period varied from 3.8 to 29.6 months). In comparing the results of PMT ± CDT with CDT alone, six studies were included (195 patients in the PMT ± CDT group and 193 patients in the CDT group). The partial thrombolysis rate was higher in the PMT ± CDT group (odds ratio [OR], 2.64; 95% CI, 1.34-5.21; P = .005), whereas the complete lysis rate was not (OR, 1.38; 95% CI, 0.87-2.18; P = .17). The difference between the Villalta scores of the two groups during follow-up had no statistical significance (OR, -0.50; 95% CI, -1.34 to 0.34; P = .24). The thrombolytic drug dose in the PMT ± CDT group was much lower than that in the CDT group (standard mean difference, -0.98; 95% CI, -1.59 to -0.38; P = .001), and the procedural time was shorter in the PMT ± CDT group (mean difference, -16.94; 95% CI, -22.38 to -11.50; P < .00,001). There was no significant difference in major bleeding (OR, 1.20; 95% CI, 0.50-2.90; P = .24) or pulmonary embolism (OR, 1.18; 95% CI, 0.16-8.73; P = .87) between the two groups. CONCLUSIONS: PMT with or without CDT is a relatively effective and safe approach for lower extremity DVT patients because of the acceptable incidence of perioperative complications and satisfying short- or long-term outcomes.
OBJECTIVE: The objective of this review was to evaluate the efficacy and safety of percutaneous mechanical thrombectomy (PMT) with or without catheter-directed thrombolysis (CDT) in the treatment of lower extremity deep venous thrombosis (DVT). METHODS: We searched PubMed for clinical trials and prospective or retrospective case series (comparative or single-arm studies) that focused on PMT ± CDT in the treatment of DVT, published before March 2, 2017. We meta-analyzed perioperative outcomes and complications and long-term outcomes of this procedure. We also compared the results between PMT ± CDT and CDT alone, using the data from comparative studies. RESULTS: Overall, 1323 PMT ± CDTpatients from 35 studies were included in our study. The rate of patients experiencing successful thrombolysis with a partial or complete lysis rate was 93.4% (95% confidence interval [CI], 90.1%-95.6%) or 67.0% (95% CI, 59.1%-76.4%), respectively. The pooled proportion of 30-day rethrombosis rate was 11.9% (95% CI, 6.7%-20.3%). The 30-day DVT-related mortality was 2.4% (95% CI, 1.6%-3.7%). The perioperative incidence of major bleeding and pulmonary embolism was 4.6% (95% CI, 2.9%-7.3%) and 3.8% (95% CI, 2.5%-6.7%), respectively. During the follow-up, the late rethrombosis rate was 10.7% (95% CI, 8.7%-13.0%; the average follow-up period ranged from 2.8 to 32.1 months). About 15.1% (95% CI, 9.6%-22.9%) of patients developed post-thrombotic syndrome during follow-up (the average follow-up period varied from 3.8 to 29.6 months). In comparing the results of PMT ± CDT with CDT alone, six studies were included (195 patients in the PMT ± CDT group and 193 patients in the CDT group). The partial thrombolysis rate was higher in the PMT ± CDT group (odds ratio [OR], 2.64; 95% CI, 1.34-5.21; P = .005), whereas the complete lysis rate was not (OR, 1.38; 95% CI, 0.87-2.18; P = .17). The difference between the Villalta scores of the two groups during follow-up had no statistical significance (OR, -0.50; 95% CI, -1.34 to 0.34; P = .24). The thrombolytic drug dose in the PMT ± CDT group was much lower than that in the CDT group (standard mean difference, -0.98; 95% CI, -1.59 to -0.38; P = .001), and the procedural time was shorter in the PMT ± CDT group (mean difference, -16.94; 95% CI, -22.38 to -11.50; P < .00,001). There was no significant difference in major bleeding (OR, 1.20; 95% CI, 0.50-2.90; P = .24) or pulmonary embolism (OR, 1.18; 95% CI, 0.16-8.73; P = .87) between the two groups. CONCLUSIONS:PMT with or without CDT is a relatively effective and safe approach for lower extremity DVTpatients because of the acceptable incidence of perioperative complications and satisfying short- or long-term outcomes.