January  2016

Hybrid Operative Thrombectomy Demonstrates

Noninferiority Versus Percutaneous Techniques for the

Treatment Acute Iliofemoral Deep Vein Thrombosis

L. E. Rodriguez, R. Figueroa-Vicente, A.-Aboukhei-Aboukheir, L. Torruella-Bartolomei, J.Martinez-Trabal.
St. Lukes Memorial Hospital, Utica, NY

Background: Hybrid operative thrombectomy (HOT) is a noveltechnique for the treatment of iliofemoral deep vein thrombosis (IFDVT)that is distinguished by retrograde access (via femoral venotomy) to thedistal venous segments. In this study, we compare perioperative and intermediate outcomes of hybrid operative thrombectomy vs percutaneous techniques (PT) in the setting of IFDVT.

Methods: From August 2008 to May 2014, 64 consecutive patient were treated with either PT (n ¼ 36) or HOT (n ¼ 28) for acute IFDVT angioplasty with or without stent. PT included catheter directed thrombolysis (CDT) with or without pharmacomechanical thrombectomy (PMT). Perioperative outcomes, technical success (>50% thrombus resolution), and thrombus resolution (partial vs complete) were analyzed between the two treatment groups. CEAP classification and venous duplex at intermediate follow-up were also analyzed.

Results:  The left limb was the most common site of the IFDVT in both groups. Technical success was 100% in both groups, and at least 80% thrombus resolution was achieved in both treatment arms. There was a trend towards a greater postoperative percent drop in Hgb in the PT group (18.3% vs 23.4%; P ¼ .09), which did not reach statistical significance. PT patients were transfused more PRBC units postoperatively than HOT (P ¼ .046). PT patients had a significantly longer length of stay (9.7 vs 13.4 days; P ¼ .028) when compared to HOT. At intermediate followup, there was no difference between HOT vs PT in mean reflux times (1.56 vs 1.51 sec; P ¼ .81) at the femoral-popliteal segment. At a mean follow up time of 1.5 years the clinical CEAP classification at the surgical limb was 3 or less in the majority of patients in both groups.

Conclusions: In our experience, PT andHOThave demonstrated very good outcomes in the perioperative and intermediate periods.HOT is noninferior to PT as a technique for early thrombus removal and has the advantage that thrombolytic therapy is not required, thrombus resolution is established in one operation, and length of stay is significantly decreased.

Author Disclosures: L. E. Rodriguez: Nothing to disclose; R. Figueroa- Vicente: Nothing to disclose; A. Aboukheir-Aboukheir: Nothing to disclose; L. Torruella-Bartolomei: Nothing to disclose; J. Martinez-Trabal: Nothing to disclose.

© 2016 Published by Elsevier Inc.

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