Clinical efficacy of one-stage thrombus removal via contralateral femoral and ipsilateral tibial venous access for pharmacomechanical thrombectomy in entire-limb acute deep vein thrombosis: a retrospective cohort study.

Abstract Objective The present study aimed to compare the early results between different approaches for pharmacomechanical thrombectomy (PMT) in the treatment of entire-limb acute deep vein thrombosis (DVT). Methods This retrospective cohort study included patients with entire-limb acute DVT who were treated by PMT from January 2016 to March 2019 at two independent vascular centers. At the first center (Renji Hospital), vascular surgeons used contralateral femoral venous access or ipsilateral tibial venous access (CFVA/ITVA). All consecutive patients with entire-limb acute DVT underwent PMT through CFVA/ITVA at the first center. At the second center (Affiliated Hangzhou First People’s Hospital), vascular surgeons conducted PMT through the traditional approach via ipsilateral popliteal venous access (IPVA). All consecutive patients underwent PMT through IPVA at the second center. Primary endpoint was incidence of post-thrombotic syndrome (PTS). Secondary endpoints included thrombus removal grade, venous primary patency rate, and incidence of moderate-to-severe PTS. Results A total of 73 patients were enrolled in this study, including 37 patients with CFVA/ITVA at the first center and 36 patients with IPVA at the second center. No significant difference was detected between the two groups in age, gender, onset time, affected limb, and risk factors. The proportion of patients who had catheter-directed thrombolysis (CDT) was significantly lower in the CFVA/ITVA group than that in the IPVA group (P=0.010). Patients achieved thrombus removal grade III more often in the CFVA/ITVA than in the IPVA group (P=0.007). PTS incidence was significantly lower in the CFVA/ITVA group than that in the IPVA group (P=0.043). The thrombus removal grade and the access were the independent factors associated with the development of PTS. Patients with complete thrombus removal (grade III) and CFVA/ITVA had a significantly low incidence of PTS. Conclusions PMT can increase thrombus clearance rate, reduce the requirement for subsequent CDT and potentially decrease the incidence of PTS through CFVA/ITVA as compared to traditional IPVA in the treatment of entire-limb acute DVT.