Meta-analysis and systematic review of percutaneous mechanical thrombectomy for lower extremity deep vein thrombosis

Abstract

Objective: The objective of this review was to evaluate the efficacy and safety of percutaneous mechanical thrombectomy (PMT) with or without catheter-directed thrombolysis (CDT) in the treatment of lower extremity deep venous thrombosis (DVT).

Methods: We searched PubMed for clinical trials and prospective or retrospective case series (comparative or single-arm studies) that focused on PMT ± CDT in the treatment of DVT, published before March 2, 2017. We meta-analyzed perioperative outcomes and complications and long-term outcomes of this procedure. We also compared the results between PMT ± CDT and CDT alone, using the data from comparative studies.

Results: Overall, 1323 PMT ± CDT patients from 35 studies were included in our study. The rate of patients experiencing successful thrombolysis with a partial or complete lysis rate was 93.4% (95% confidence interval [CI], 90.1%-95.6%) or 67.0% (95% CI, 59.1%-76.4%), respectively. The pooled proportion of 30-day rethrombosis rate was 11.9% (95% CI, 6.7%-20.3%). The 30-day DVT-related mortality was 2.4% (95% CI, 1.6%-3.7%). The perioperative incidence of major bleeding and pulmonary embolism was 4.6% (95% CI, 2.9%-7.3%) and 3.8% (95% CI, 2.5%-6.7%), respectively. During the follow-up, the late rethrombosis rate was 10.7% (95% CI, 8.7%-13.0%; the average follow-up period ranged from 2.8 to 32.1 months). About 15.1% (95% CI, 9.6%-22.9%) of patients developed post-thrombotic syndrome during follow-up (the average follow-up period varied from 3.8 to 29.6 months). In comparing the results of PMT ± CDT with CDT alone, six studies were included (195 patients in the PMT ± CDT group and 193 patients in the CDT group). The partial thrombolysis rate was higher in the PMT ± CDT group (odds ratio [OR], 2.64; 95% CI, 1.34-5.21; P = .005), whereas the complete lysis rate was not (OR, 1.38; 95% CI, 0.87-2.18; P = .17). The difference between the Villalta scores of the two groups during follow-up had no statistical significance (OR, -0.50; 95% CI, -1.34 to 0.34; P = .24). The thrombolytic drug dose in the PMT ± CDT group was much lower than that in the CDT group (standard mean difference, -0.98; 95% CI, -1.59 to -0.38; P = .001), and the procedural time was shorter in the PMT ± CDT group (mean difference, -16.94; 95% CI, -22.38 to -11.50; P < .00,001). There was no significant difference in major bleeding (OR, 1.20; 95% CI, 0.50-2.90; P = .24) or pulmonary embolism (OR, 1.18; 95% CI, 0.16-8.73; P = .87) between the two groups.

Conclusions: PMT with or without CDT is a relatively effective and safe approach for lower extremity DVT patients because of the acceptable incidence of perioperative complications and satisfying short- or long-term outcomes.

Keywords: Catheter-directed thrombolysis (CDT); Efficacy; Lower extremity deep venous thrombosis (DVT); Percutaneous mechanical thrombectomy (PMT); Safety.