Combined Aspiration–Maceration Thrombectomy with Catheter-Directed Thrombolysis for Proximal Lower Limb DVT: A Prospective Study

Abstract

Background: Deep vein thrombosis (DVT) contributes significantly to morbidity and mortality despite standard anticoagulation. Endovascular therapies, including catheter-directed thrombolysis (CDT) and pharmacomechanical thrombectomy, aim to expedite thrombus clearance and reduce post-thrombotic syndrome (PTS). However, trials like CaVenT and ATTRACT have shown mixed efficacy.

Aim: To evaluate a hybrid technique combining aspiration–maceration thrombectomy with CDT in acute and subacute proximal lower limb DVT and to compare outcomes between the two groups.

Methods: In this single-centre prospective study, 67 patients with acute or subacute proximal lower limb DVT underwent aspiration–maceration thrombectomy with catheter-directed Tenecteplase infusion. IVC filters and venous stents were used when indicated. Recanalization was graded using Society of Interventional Radiology (SIR) criteria. Outcomes included pain, limb edema, PTS (Villalta score), and VEINES-QOL scores.

Results: Post-procedure, 98.5% of patients had SIR Grade II/III thrombus removal; 63% achieved complete (Grade III) lysis. At 3 months, 91% had full recanalization on ultrasound. Acute DVT patients had better outcomes than subacute: 81% vs 40% achieved initial complete lysis (p<0.01), and all acute DVT cases vs 80% subacute achieved full recanalization at 3 months (p=0.006). Mean VAS pain score reduced from 7.1 to 1.0 (p<0.001). Limb edema resolved in 69% by 3 months. VEINES-QOL scores improved from 43 to 92. Only 7 patients (10.4%) had mild/moderate PTS.

Conclusions: This low-cost, combined aspiration–maceration thrombectomy with CDT achieved rapid and durable recanalization with significant symptom relief and low PTS incidence, especially in acute DVT. It offers a safe, effective alternative for early DVT intervention