Mechanical Venous Thrombectomy for Deep Venous Thrombosis in Cancer Patients: A Single-Center Retrospective Study

• Published in: Cardiovascular and interventional radiology Vol. 47; no. 5; pp. 556 - 566
• Main Authors: Patel, Riya M., Pal, Koustav, Ahmed, Syed Hadi, Kuban, Joshua D., Patel, Milan, Shah, Ketan, Habibollahi, Peiman, Metwalli, Zeyad, Gurusamy, Varshana, Gupta, Sanjay, Rojas-Hernandez, Cristhiam M., Afshar-Kharghan, Vahid, Kroll, Michael H., Sheth, Rahul A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2024; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Blood clots; Cancer; Cardiology; Cardiovascular system; Clinical Investigation; Female; Humans; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasms - complications; Nuclear Medicine; Radiology; Retrospective Studies; Success; Survival; Thrombectomy - methods; Thromboembolism; Thrombosis; Treatment Outcome; Tumors; Ultrasound; Venous Interventions; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - therapy; Mechanical thrombectomy; Endovascular; Venous thromboembolism; Cancer
• ISSN: 0174-1551; 1432-086X; 1432-086X
• DOI: 10.1007/s00270-024-03691-3

Purpose Venous thromboembolism (VTE) is a major contributor to the mortality of cancer patients. Mechanical thrombectomy (MT) is an endovascular technique that physically removes a thrombus without thrombolytics. The purpose of this study was to evaluate safety, efficacy, and clinical outcomes following MT for lower extremity DVT in cancer patients. Methods This single-center, retrospective study evaluated outcomes following MT of lower extremity DVT in cancer patients from November 2019 to May 2023. The primary outcome measure was clinical success, defined as a decrease in Villalta score by at least 2 points following the intervention. Secondary outcomes included repeat intervention-free survival and overall survival. Technical success was defined as restoring venous flow with mild (< 10%) or no residual filling defect. Results In total, 90 patients and 113 procedures were included. Technical and clinical success was achieved in 81% and 87% of procedures performed. Repeat intervention-free survival at 1 month, 3 months, and 6 months post-procedure was 92%, 82%, and 77%, respectively. The complication rate was 2.7%. Pathologic analysis of the extracted thrombus revealed tumor thrombus in 18.4% (18/98) samples. Overall survival for the study cohort was 87% at 1 month, 74% at 3 months, and 62% at 6 months. Patients who were found to have tumor thrombi were noted to have a decreased overall survival compared to patients with non-tumor thrombi ( P  = 0.012). Conclusion MT is safe and efficacious in reducing cancer patients’ VTE-related symptoms. The high rate of tumor thrombus in thrombectomy specimens suggests this phenomenon is more common than suspected. Graphical Abstract