AVF Journal Club: DVT Thrombectomy and FLAME PE Study

Mechanical Thrombectomy Outperforms Lytics for Iliofemoral DVT

Propensity matched comparison of 130 patients found mechanical thrombectomy achieved 87.7 percent versus 67.5 percent thrombus clearance and 83 percent freedom from post-thrombotic syndrome versus 63.6 percent with lytics, with lower Villalta scores and shorter hospital stays.

Clinical Pearls: Anticoagulation and When Lytics Still Help

Panelists never stop anticoagulation around thrombectomy, favoring heparin then lovenox before a DOAC, and reserve lytics for uncertain inflow, prior iliocaval reconstruction, or obese patients needing pedal access.

FLAME Study: FlowTriever Reduces High-Risk PE Mortality

Among 115 high risk pulmonary embolism patients, the composite endpoint of mortality, bailout, deterioration, or bleeding occurred in 17 percent of the thrombectomy arm versus 63.9 percent with lytics or anticoagulation, with in-hospital mortality of 1.9 percent versus 29.5 percent.

Clinical Pearls: ECMO Timing and Risk Stratification

Panelists escalate to ECMO before decompensation, proceed directly to thrombectomy after cannulation, wait six hours after lytics before reassessing right ventricular recovery, and noted advanced shock patients given thrombectomy had zero mortality versus 49 percent otherwise.