ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Thrombosis and Haemostasis
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1567342
Venous Microtrauma Associated with Pharmacomechanical Catheter-Directed Thrombolysis in A Large Animal Acute Deep Venous Thrombosis Model
Provisionally accepted
Mohamed Zaghloul1
Sophia R Pyeatte1Shahab Hafezi1
Usama Ismail1
Rodrigo Meade1Batool Arif1Roger Rowe2Luis Sanchez1
Mohamed Adel Zayed1*- 1School of Medicine, Washington University in St. Louis, St. Louis, United States
- 2Caeli Vascular, Inc., St. Louis, United States
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Background: Pharmacomechanical catheter-directed thrombolysis (PCDT) is commonly used to treat acute deep venous thrombosis (DVT). The AngioJet Rheolytic Thrombectomy (ART) device is a widely used option. However, previous serious adverse events led to an FDA black-box warning. Limited large animal studies have assessed ART's efficacy and safety. We investigated the periprocedural outcomes and venous histomorphic impact of ART in a novel large animal acute DVT model. Methods: Six adult male Yorkshire pigs (96 – 113 kilograms) underwent general anesthesia and continuous hemodynamic monitoring. Acute DVT was induced in the infrarenal IVC using occlusive balloons. Three pigs were treated with ART’s thrombectomy mode (MT) for 10 minutes. Another three pigs underwent PCDT with 250mL saline and 50,000 IU Streptokinase over 10 minutes. Serial venograms assessed thrombus formation and post-treatment results, and then iliocaval venous segments were resected for histomorphic analysis. Results: ART significantly reduced thrombus in all pigs without complications (64.7% ± 9.7% vs. 16.1% ± 10.5%; P = 0.02). Retroperitoneal staining was observed around treated venous segments in all pigs, with a higher mean staining score in the PCDT group compared to the MT group (2 ± 0 vs. 1.3 ± 0.57; P = 0.11). Histopathology revealed more venous wall intimal tears in ART-treated segments compared to untreated segments (18 ± 5.79 vs. 6.3 ± 2.51, P = 0.01). Conclusions: ART effectively removes acute thrombus in a large animal DVT model without periprocedural complications. The observed retroperitoneal staining following PCDT raises some concerns regarding venous wall integrity following ART, for which the long-term consequences are unknown.
Keywords: Deep venous thrombosis, pharmacomechanical catheter-directed thrombolysis, Angiojet rheolytic thrombectomy, large animal model, Venous Wall Injury
Received: 27 Jan 2025; Accepted: 02 Jun 2025.
Copyright: © 2025 Zaghloul, Pyeatte, Hafezi, Ismail, Meade, Arif, Rowe, Sanchez and Zayed. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mohamed Adel Zayed, School of Medicine, Washington University in St. Louis, St. Louis, United States
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