The role of vacuum assisted thrombectomy (AngioVac) in treating chronic venous thromboembolic disease. Systematic review and a single center's experience

Abstract

Background: Beyond medical therapy, the role of endovascular approach for the management of chronic Venous Thromboembolic (VTE) disease is yet to be defined. To our knowledge, no systematic reviews or guidelines are available that provide information on how to manage this chronic condition. This paper represents the first systematic review of published reports on the use of vacuum-assisted thrombectomy (AngioVac) in treating chronic VTE disease.

Methods: A systematic review of published case-series, individual case-reports, and review articles in MEDLINE, PubMed, and Google Scholar was conducted. Keywords used for the search were: "vacuum assisted thrombectomy", "AngioVac", "thrombectomy", and "chronic venous thrombosis". Inclusion criteria were a diagnosis of chronic DVT (>28 days) and the use of vacuum-assisted thrombectomy device (AngioVac) with or without additional endovascular therapy. Our selection process followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The literature search was conducted through June 2017.

Results: The initial search yielded 51 publications of which 18 reported the use of vacuum assisted thrombectomy (AngioVac) in treatment of venous thrombosis but only 7 reports (13 patients) met our inclusion criteria. Similarly, 5 patients representing our center's experience were included in the analysis. Patients' demographics, admission diagnoses, risk factors, and procedural success were individually reported. Procedural success (both partial and complete resolution of thrombus burden) was achieved in 15 of the 18 cases (83%). Failure to re-canalize or significantly improve venous flow was seen in only 3 cases. No procedural mortality was reported. However, in-hospital and long-term mortality rates were not reported.

Conclusion: Vacuum-assisted thrombectomy using the AngioVac system is a minimally invasive alternative to surgical thrombectomy for chronic VTE management. The use of this device in iliocaval thrombosis appears to be safe and effective compared to other anatomical locations. Further outcome studies are needed to define long-term benefits of mechanical thrombectomy in treating chronic VTE diseases.

Keywords: Endovascular thrombectomy; Venous thrombosis.