By Muhammad A. Chaudhry, M.D.
The Trellis thrombectomy system (Covidien) is one of the newer devices that incorporates isolated pharmacomechanical thrombectomy and thrombolysis (PMT) for treatment of deep venous thrombosis (DVT). We conducted a retrospective study of patients with upper- and lower-extremity DVT managed with the Trellis thrombectomy system over a one year period. We were amazed by the excellent outcomes with this relatively new technique which was substantially better than we expected, especially in terms of technical success and post-procedural complications.
Twenty-eight patients (mean age, 46.4 ± 21.2 years) presented with symptoms with a mean duration of 1.3 ± 1.8 months. Eighty-six percent had 100% occlusion on admission, while 14.3% had 70%-90% stenosis. The mean lytic dose used was tPA 20.7 ± 12 mg. The mean Trellis treatment time was 25.1 ± 11.5 minutes. Grade 3 lysis was achieved in 85.8% of patients while grade 2 lysis was achieved in 14.2%. Mean total hospital stay was 2.6 ± 2.7 days. Postprocedure symptom resolution was 100%, and there was no reocclusion in 78.6% of patients at 1 year. At 12 months, the patency rate (primary or secondary) was 80% as determined by Doppler ultrasound.
As compared to previous published outcomes, our study showed exceedingly promising results as detailed above. In patients with DVT involving the ilio-femoral and the upper-extremity vessels, the use of the Trellis device was associated with a high technical success rate as well as a satisfactory 12-month patency rate. Moreover, this strategy was associated with reduced lytic dose, shorter treatment time and hospital stay, and no bleeding complications. Our experience is the largest to date by an interventional cardiology group and we hope to extend this further with a considerably bigger group of patients in the future. Of course, acquisition of skill and expertise in the long run will lead to greater uniformity of results in diverse clinical settings in the future.
Muhammad A. Chaudhry is from the Department of Cardiology at the Scripps Green Hospital, Heart Failure Recovery and Research, 10666 North Torrey Pines Road, La Jolla, CA 92037. You can reach him via Email at email@example.com
Chaudhry MA, Pappy R, Hennebry TA, .Use of the Trellis Device in the Management of Deep Vein Thrombosis: A Retrospective Single-Center Experience. J Invasive Cardiol 2013;25(7): 296-299