Pascale Notten1,2, Carsten W K P Arnoldussen3,4, Rutger Brans3, André A E A de Smet5, Lidwine W Tick6, Marlène H W van de Poel7, Otmar R M Wikkeling8, Louis-Jean Vleming9, Ad Koster10, Kon-Siong G Jie11, Esther M G Jacobs12, Harm P Ebben13, Nils Planken14, Hugo Ten Cate2,15,16, Cees H A Wittens1, Arina J Ten Cate-Hoek2,15,16. 1. Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. 2. Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands. 3. Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands. 4. Department of Radiology and Nuclear Medicine, VieCuri Medical Centre, Venlo, The Netherlands. 5. Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands. 6. Department of Internal Medicine, Maxima Medical Centre, Eindhoven, The Netherlands. 7. Department of Internal Medicine, Laurentius Hospital, Roermond, The Netherlands. 8. Department of Vascular Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands. 9. Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands. 10. Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands. 11. Department of Internal Medicine, Zuyderland Medical Centre, Sittard, The Netherlands. 12. Department of Internal Medicine, Elkerliek Hospital, Helmond, The Netherlands. 13. Department of Vascular Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands. 14. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands. 15. Laboratory for Clinical Thrombosis and Hemostasis, Maastricht University, Maastricht, The Netherlands. 16. Thrombosis Expertise Centre, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.
Abstract
BACKGROUND: The CAVA trial did not show the anticipated risk reduction for postthrombotic syndrome (PTS) after thrombus removal via additional ultrasound-accelerated catheter-directed thrombolysis (UACDT) in patients with acute iliofemoral deep vein thrombosis (IFDVT). Difficulties in achieving an effective degree of recanalization through thrombolysis may have influenced outcomes. We therefore assessed whether successful UACDT (restored patency ≥ 90%) did reduce the development of PTS. METHODS: This CAVA trial post hoc analysis compared the proportion of PTS at 1-year follow-up between patients with successful UACDT and patients that received standard treatment only. In addition, clinical impact as well as determinants of successful thrombolysis were explored. RESULTS:UACDT was initiated in 77 (50.7%) patients and considered successful in 41 (53.2%, interrater agreement κ = 0.7, 95% confidence interval 0.47-0.83). PTS developed in 15/41 (36.6%) patients in the successful UACDT group versus 33/75 (44.0%) controls (p = 0.44). In this comparison, successful UACDT was associated with lower Venous Clinical Severity Score (3.50 ± 2.57 vs. 4.82 ± 2.74, p = 0.02) and higher EuroQOL-5D (EQ-5D) scores (40.2 ± 36.4 vs. 23.4 ± 34.4, p = 0.01). Compared with unsuccessful UACDT, successful UACDT was associated with a shorter symptom duration at inclusion (p = 0.05), and higher rates of performed adjunctive procedures (p < 0.001) and stent placement (p < 0.001). CONCLUSION: Successful UACDT was not associated with a reduced proportion of PTS 1 year after acute IFDVT compared with patients receiving standard treatment alone. There was, however, a significant reduction in symptom severity and improvement of generic quality of life according to the EQ-5D. Better patient selection and optimization of treatment protocols are needed to assess the full potential of UACDT for the prevention of PTS. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov number, NCT00970619. Georg Thieme Verlag KG Stuttgart · New York.
RCT Entities:
BACKGROUND: The CAVA trial did not show the anticipated risk reduction for postthrombotic syndrome (PTS) after thrombus removal via additional ultrasound-accelerated catheter-directed thrombolysis (UACDT) in patients with acute iliofemoral deep vein thrombosis (IFDVT). Difficulties in achieving an effective degree of recanalization through thrombolysis may have influenced outcomes. We therefore assessed whether successful UACDT (restored patency ≥ 90%) did reduce the development of PTS. METHODS: This CAVA trial post hoc analysis compared the proportion of PTS at 1-year follow-up between patients with successful UACDT and patients that received standard treatment only. In addition, clinical impact as well as determinants of successful thrombolysis were explored. RESULTS:UACDT was initiated in 77 (50.7%) patients and considered successful in 41 (53.2%, interrater agreement κ = 0.7, 95% confidence interval 0.47-0.83). PTS developed in 15/41 (36.6%) patients in the successful UACDT group versus 33/75 (44.0%) controls (p = 0.44). In this comparison, successful UACDT was associated with lower Venous Clinical Severity Score (3.50 ± 2.57 vs. 4.82 ± 2.74, p = 0.02) and higher EuroQOL-5D (EQ-5D) scores (40.2 ± 36.4 vs. 23.4 ± 34.4, p = 0.01). Compared with unsuccessful UACDT, successful UACDT was associated with a shorter symptom duration at inclusion (p = 0.05), and higher rates of performed adjunctive procedures (p < 0.001) and stent placement (p < 0.001). CONCLUSION: Successful UACDT was not associated with a reduced proportion of PTS 1 year after acute IFDVT compared with patients receiving standard treatment alone. There was, however, a significant reduction in symptom severity and improvement of generic quality of life according to the EQ-5D. Better patient selection and optimization of treatment protocols are needed to assess the full potential of UACDT for the prevention of PTS. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov number, NCT00970619. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Carsten W K P Arnoldussen; Pascale Notten; Rutger Brans; Dammis Vroegindeweij; Lidwine W Tick; Marlène H W van de Poel; Otmar R M Wikkeling; Louis-Jean Vleming; Ad Koster; Kon-Siong G Jie; Esther M G Jacobs; Nils Planken; Cees H A Wittens; Hugo Ten Cate; Joachim E Wildberger; Arina J Ten Cate-Hoek Journal: Eur Radiol Date: 2022-03-28 Impact factor: 7.034