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

• DOI: 10.1007/s00270-024-03691-3
• Publication Date: 2024-03-28T17:01:50Z
• Authors: Riya M. Patel; Koustav Pal; Syed Hadi Ahmed; Joshua D. Kuban; Milan Patel; Ketan Shah; Peiman Habibollahi; Zeyad Metwalli; Varshana Gurusamy; Sanjay Gupta; Cristhiam M. Roja...; Vahid Afshar-Khar...; Michael H. Kroll; Rahul A. Sheth
• Keywords: Male; Venous Thrombosis; Adult; Aged, 80 and over; Middle Aged; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Neoplasms; Humans; Female; Clinical Investigation; Retrospective Studies; Aged; Thrombectomy

Abstract 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