1Dr Saad Rehman,1Dr Mohammed Khader, 1Dr Rahil Kassamali, 1Dr Ayman Elmagdoub
1Hamad Medical Corporation
To stratify patients in order to provide successful single session thrombolysis.
Material(s) and Method(s):
Angiojet mechanical thrombectomy is a well-established tool in the treatment of DVT. In our institute, we use angiojet for DVT, Renal fistula, and PE thrombolysis. As we don’t have EKOS systems we worked to increase efficacy and improve results of mechanical thrombectomy. We used thrombus load scoring based on the length of involved veins and D-dimers. The patient who had a higher score were treated with modified techniques. In our technique, we used the following sequence; Thrombectomy mode — power pulse mode — balloon maceration — thrombectomy mode. This technique results in increased operating time and more radiation exposure. Hence we scored the patients and only those having higher scores were selected for this modified technique.
We aimed for inline flow with no significant narrowing or remaining thrombus at the end of the procedure and no further IR input was needed. 23 patients were selected. In 22 we achieved complete clearance in a single session. Only one patient required suction thrombectomy (Penumbra) to clear the clot completely. Haemoglobinuria was observed in 15 out of 23 patients with a transient rise in renal function seen in 3 patients only. No other major complication occurred.
In our experience heavy thrombus load, venous thromboembolism can be treated with angiojet alone successfully with modified use. Patient selection criteria are important as only heavy thrombus load justifies increased radiation exposure and potential renal injury.