Suresh Vedantham1, Amber Salter2, Samantha Lancia2, Lawrence Lewis3, Siddhant Thukral4, Susan R Kahn5. 1. Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri. Electronic address: vedanthams@wustl.edu. 2. Division of Biostatistics, Washington University, St. Louis, Missouri. 3. Department of Emergency Medicine, Washington University, St. Louis, Missouri. 4. School of Medicine, University of Missouri, Kansas City, Missouri. 5. Department of Medicine, McGill University, Division of Internal Medicine & Center for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.
Abstract
PURPOSE: To describe the clinical outcomes of a pharmacomechanical catheter-directed venous thrombolysis (PCDT) strategy that included AngioJet rheolytic thrombectomy. METHODS: In the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis multicenter randomized trial, physicians at 33 sites designated AngioJet as their preferred device for PCDT. In these sites, 364 patients with acute proximal lower-extremity deep vein thrombosis (DVT) were randomized to a strategy of PCDT that incorporated either AngioJet along with anticoagulation or anticoagulation alone. Relief from presenting DVT symptoms was evaluated over 30 days of follow-up. Postthrombotic syndrome (PTS), quality of life (QOL), recurrent venous thromboembolism (VTE), and safety were evaluated over 24 months of follow-up. RESULTS: Within 30 days, AngioJet-PCDT led to a greater improvement in leg swelling (mean difference calf circumference 0.55 cm, P = .009), venous QOL (mean difference 6.5 Venous Insufficiency Epidemiologic and Economic Study [VEINES]-QOL points, P = .0073), and venous symptoms (mean difference 5.6 VEINES-symptoms points, P = .0134) than control, with differences most apparent in iliofemoral DVT. AngioJet-PCDT reduced PTS at 6 months (24% with AngioJet-PCDT vs 40% with control, P = .003) but did not influence PTS or QOL between 12 and 24 months. Major bleeding, pulmonary embolism, renal failure, and bradycardia were infrequent with AngioJet-PCDT (<2% each), but 24-month VTE recurrence may have been more frequent (13.9% with AngioJet-PCDT vs 6.8% with control, P = .03) CONCLUSIONS: In patients with acute proximal DVT, a treatment strategy that included first-line AngioJet-PCDT was reasonably safe and led to an improved symptom status and venous QOL at 1 month and reduced PTS at 6 months compared with anticoagulation alone. However, AngioJet-PCDT did not influence PTS or the QOL beyond 6 months and may have increased recurrent VTE.
PURPOSE: To describe the clinical outcomes of a pharmacomechanical catheter-directed venous thrombolysis (PCDT) strategy that included AngioJet rheolytic thrombectomy. METHODS: In the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis multicenter randomized trial, physicians at 33 sites designated AngioJet as their preferred device for PCDT. In these sites, 364 patients with acute proximal lower-extremity deep vein thrombosis (DVT) were randomized to a strategy of PCDT that incorporated either AngioJet along with anticoagulation or anticoagulation alone. Relief from presenting DVT symptoms was evaluated over 30 days of follow-up. Postthrombotic syndrome (PTS), quality of life (QOL), recurrent venous thromboembolism (VTE), and safety were evaluated over 24 months of follow-up. RESULTS: Within 30 days, AngioJet-PCDT led to a greater improvement in leg swelling (mean difference calf circumference 0.55 cm, P = .009), venous QOL (mean difference 6.5 Venous Insufficiency Epidemiologic and Economic Study [VEINES]-QOL points, P = .0073), and venous symptoms (mean difference 5.6 VEINES-symptoms points, P = .0134) than control, with differences most apparent in iliofemoral DVT. AngioJet-PCDT reduced PTS at 6 months (24% with AngioJet-PCDT vs 40% with control, P = .003) but did not influence PTS or QOL between 12 and 24 months. Major bleeding, pulmonary embolism, renal failure, and bradycardia were infrequent with AngioJet-PCDT (<2% each), but 24-month VTE recurrence may have been more frequent (13.9% with AngioJet-PCDT vs 6.8% with control, P = .03) CONCLUSIONS: In patients with acute proximal DVT, a treatment strategy that included first-line AngioJet-PCDT was reasonably safe and led to an improved symptom status and venous QOL at 1 month and reduced PTS at 6 months compared with anticoagulation alone. However, AngioJet-PCDT did not influence PTS or the QOL beyond 6 months and may have increased recurrent VTE.
Authors: Suresh Vedantham; Clement J Grassi; Hector Ferral; Nilesh H Patel; Patricia E Thorpe; Vittorio P Antonacci; Bertrand M Janne d'Othée; Lawrence V Hofmann; John F Cardella; Sanjoy Kundu; Curtis A Lewis; Marc S Schwartzberg; Robert J Min; David Sacks Journal: J Vasc Interv Radiol Date: 2006-03 Impact factor: 3.464
Authors: Michael A Vasquez; Eberhard Rabe; Robert B McLafferty; Cynthia K Shortell; William A Marston; David Gillespie; Mark H Meissner; Robert B Rutherford Journal: J Vasc Surg Date: 2010-09-27 Impact factor: 4.268
Authors: Anthony J Comerota; Clive Kearon; Chu-Shu Gu; Jim A Julian; Samuel Z Goldhaber; Susan R Kahn; Michael R Jaff; Mahmood K Razavi; Andrei L Kindzelski; Riyaz Bashir; Parag Patel; Mel Sharafuddin; Michael J Sichlau; Wael E Saad; Zakaria Assi; Lawrence V Hofmann; Margaret Kennedy; Suresh Vedantham Journal: Circulation Date: 2019-02-26 Impact factor: 29.690
Authors: Ido Weinberg; Suresh Vedantham; Amber Salter; Gail Hadley; Noor Al-Hammadi; Clive Kearon; Jim A Julian; Mahmood K Razavi; Heather L Gornik; Samuel Z Goldhaber; Anthony J Comerota; Andrei L Kindzelski; Robert M Schainfeld; John F Angle; Sanjay Misra; Jonathan A Schor; Darren Hurst; Michael R Jaff Journal: Vasc Med Date: 2019-07-27 Impact factor: 3.239
Authors: Clive Kearon; Chu-Shu Gu; Jim A Julian; Samuel Z Goldhaber; Anthony J Comerota; Heather L Gornik; Timothy P Murphy; Laurence Lewis; Susan R Kahn; Andrei L Kindzelski; Dennis Slater; Randolph Geary; Ronald Winokur; Kannan Natarajan; Alan Dietzek; Daniel A Leung; Stanley Kim; Suresh Vedantham Journal: Thromb Haemost Date: 2019-01-30 Impact factor: 5.249
Authors: Suresh Vedantham; Thomas M Vesely; Gregorio A Sicard; Daniel Brown; Brian Rubin; Luis A Sanchez; Naveen Parti; Daniel Picus Journal: J Vasc Interv Radiol Date: 2004-06 Impact factor: 3.464
Authors: Susan R Kahn; Ian Shrier; Jim A Julian; Thierry Ducruet; Louise Arsenault; Marie-José Miron; Andre Roussin; Sylvie Desmarais; France Joyal; Jeannine Kassis; Susan Solymoss; Louis Desjardins; Donna L Lamping; Mira Johri; Jeffrey S Ginsberg Journal: Ann Intern Med Date: 2008-11-18 Impact factor: 25.391
Authors: Pascale Notten; Arina J Ten Cate-Hoek; Carsten W K P Arnoldussen; Rob H W Strijkers; André A E A de Smet; 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; Harm P Ebben; Michiel Coppens; Irwin Toonder; Hugo Ten Cate; Cees H A Wittens Journal: Lancet Haematol Date: 2019-11-27 Impact factor: 18.959