To investigate the efficacy of Acostream thrombus aspiration device combined with catheter-directed thrombolysis in the treatment of acute/subacute lower extremity deep venous thrombosis(DVT).

Patients with acute/subacute lower extremity DVT treated at Nanjing First Hospital from March 2020 to November 2023 were enrolled. According to the treatment plan, they were divided into three groups: CDT alone (Group A, n=48), manual aspiration thrombectomy (MAT) + CDT (Group B, n=27), and AcoStream thrombus aspiration + CDT (Group C, n=27). Thrombus clearance rate, thrombolytic drug dosage, treatment duration, follow-up, and incidence of post-thrombotic syndrome (PTS) were compared and analyzed.

The immediate thrombus clearance rate in Group C (58.9%±12.7%) was higher than in Group B (35.1%±13.1%, P<0.001). At discharge, the thrombus clearance rate in Group C (75.1±15.3%) was higher than in Group B (57.9%±19.2%, P=0.005) and Group A (48.3%±16.6%, P<0.001), with statistically significant differences. The dosage of alteplase in Group C (38.9±18.9 mg) was lower than in Group A (73.1±34.2 mg, P<0.001) and Group B (59.6±30.2 mg, P=0.026). The thrombolytic duration in Group C (3.0±1.5 days) was shorter than in Group A (5.1±2.1 days, P<0.001) and Group B (4.5±2.1 days, P=0.031). The length of hospital stay in Group C (9.8±2.2 days) was shorter than in Group A (11.8±2.6 days, P=0.044) and Group B (11.9±4.7 days, P=0.011). The operation time in Group C (155.6±60.5 min) was longer than in Group A (88.4±34.4 min, P<0.001) and Group B (101.9±34.9 min, P=0.002). The treatment cost in Group C (CNY 81 000±20 000) was higher than in Group A (CNY 57 000±14 000, P<0.001) and Group B (CNY 69 000±23 000, P=0.019). Intraoperative blood loss in Group C (209.3±49.9 mL) was greater than in Group B (153.5±51.1 mL, P<0.001). The incidence of bleeding complications was 20.8% (10/48) in Group A, 11.1% (3/27) in Group B, and 14.8% (4/27) in Group C, with no significant difference among the groups (P=0.531). The average follow-up durations were 5.3±2.5 months, 5.1±2.5 months, and 4.9±2.3 months, respectively, with no significant difference (P=0.818). The incidences of PTS were 17.1% (7/41), 8.7% (2/23), and 12.5% (3/24), respectively, also with no significant difference (P=0.633).

AcoStream thrombus aspiration combined with CDT is safe and effective for the treatment of acute/subacute deep venous thrombosis. It improves thrombus clearance and reduces the dosage of thrombolytic drugs and thrombolysis duration. However, it is associated with longer operation time, greater intraoperative blood loss, and higher treatment costs.