Percutaneous Thrombectomy using a Computer Assisted Aspiration Device for Deep Vein Thrombosis

Research Highlights:1.Large bore aspiration using Lightning FLASH is safe and effective for deep venous thrombosis.2.Short-term post-thrombectomy patency was promising.3.Computer assisted algorithm that fine tunes the power of aspiration based on flow dynamics was associated with acceptable blood loss in the setting of 16-French compatible cannula.AbstractPurposeTo demonstrate the safety and effectiveness of a computer-assisted large bore thrombectomy (CA-LBT) device aspiration thrombectomy device for treatment of deep vein thrombosis (DVT).Materials and methodsA single institutional retrospective review was performed to include 16 consecutive patients (median age 51.1 years, range 19-77; 5 men and 11 women) who underwent percutaneous thrombectomy using a 16 Fr CA-LBT device (Lightning Flash Aspiration System,Penumbra Inc., Alameda, California, USA) for DVT (12 iliofemoral with or without caval extension [75.0%], 3 axillosubclavian [18.8%], and 1 caval [6.3%) between January 2023 and August 2023.ResultsThrombectomy was performed via the popliteal (n=10, 62.5%), femoral (n=3, 18.8%), saphenous (n=1, 6.3%), brachial (n=1, 6.3%), femoral and brachial (n=1, 6.3%) veins, with a median fluoroscopy time of 17 min (range 7.2-61min) and contrast agent volume of 110 ml (30-175 ml). Restoration of anterograde flow was achieved in all cases (100%, 16/16). Thirteen patients (81.2%) received venoplasty after thrombectomy for residual stenosis. Stents were placed in seven patients (43.8%). With a median clinical follow-up of 77 days (range 3-278 days), symptom improvement was achieved among 13/15 (86.7%) patients that initially presented with DVT associated symptoms. In 14 patients with imaging follow-up, patency was confirmed in 12 patients (85.7%). Of the two patients with complete thrombosis on follow-up imaging (14.3%), one patient was successfully treated with repeated thrombectomy using Flash technology, while the other patient was treated with systemic anticoagulation.ConclusionsAspiration thrombectomy with this 16 Fr CA-LBT device may be a feasible option for treatment of proximal or large volume DVT.Graphical abstract