Abstract No. 391 Comparison of Clinical Outcomes Between Rheolytic Thrombectomy and Large-Bore Mechanical Thrombectomy for the Treatment of Acute Deep Venous Thrombosis

There is a lack of consensus as to the cause of decreased vessel patency post-thrombectomy: residual thrombus or endothelial wall damage from the procedure. The purpose of this study is to retrospectively compare clinical and post-thrombectomy outcomes between rheolytic thrombectomy and large-bore mechanical thrombectomy for the treatment of acute deep venous thrombosis (DVT). A single-center, retrospective review of acute DVT interventions performed between January 2016 and February 2023 was performed comparing patients who underwent rheolytic thrombectomy with Angiojet ZelanteDVT (Boston Scientific) and large-bore mechanical thrombectomy with ClotTriever (Inari Medical). Patient demographics, procedure details, periprocedural anticoagulation regimen, and repeat thrombectomy procedure within 120 days of the original procedure were compared. A total of 41 patients with acute DVT were analyzed, 22 (53.7%) of which underwent rheolytic thrombectomy and 19 (46.3%) large-bore mechanical thrombectomy. Patients who underwent large-bore mechanical thrombectomy were significantly older (median age, 64 vs 48 years; p=0.009) and less likely to have a prior history of DVT (26% vs 68%; p=0.045). Large-bore mechanical thrombectomy was significantly associated with acute DVT that extended the iliofemoral and popliteal region (63% vs 23%, p=0.009). Although no significant difference was found in intraprocedural characteristics like procedure time, estimated blood loss (EBL), and placement of a stent, fewer patients who underwent large-bore mechanical thrombectomy required intraprocedural thrombolytics (21% vs 41%) or assistance with an additional thrombectomy device (0% vs 14%). Risk of requiring a repeat thrombectomy within 120 days post-procedure for acute DVT was lower with large-bore mechanical thrombectomy; however, this was not found to be significant after controlling for patient risk factors (10.5% vs 18.1%, p =0.7). No significant difference was found in the rate of repeat thrombectomy within 120 days of original procedure between rheolytic thrombectomy and large-bore mechanical thrombectomy. More studies are needed with larger cohorts and longer term follow-up to establish a correlation to residual vascular obstruction versus endothelial damage.