Vedantham Suresh, Vesely Thomas M, Parti Naveen, Darcy Michael, Hovsepian David M, Picus Daniel
Vascular and Interventional Radiology Section, Mallinckrodt Institute of Radiology, 510 South Kingshighway, Box 8131, St. Louis, Missouri 63110, USA.
J Vasc Interv Radiol. 2002 Oct;13(10):1001-8. doi: 10.1016/s1051-0443(07)61864-8.
To evaluate the use of adjunctive mechanical thrombectomy (MT) with pharmacologic catheter-directed lower extremity venous thrombolysis.
Catheter-directed thrombolysis with adjunctive MT was used to treat 28 symptomatic limbs in 20 patients (22 procedures) with lower extremity deep vein thrombosis (DVT) between August 1997 and July 2001. Procedural success, major bleeding, thrombolytic infusion time, and total thrombolytic agent dose were recorded.
Procedural success was achieved in 23 of 28 limbs (82%). Fifteen patients (18 limbs) received iliac vein stents. Major bleeding was observed after three of 22 procedures (14%) and resulted in transfusion in two patients and endometrial ablation in the third patient. Mean per-limb infusion time was 16.8 hours +/- 12.8. Mean per-limb total doses were lower than those reported in published studies of DVT thrombolysis: 2.67 million U +/- 1.60 urokinase, 18.4 mg +/- 10.7 tissue plasminogen activator, and 13.8 U +/- 6.9 reteplase. Venographic analysis demonstrated minimal thrombus removal (26.0% +/- 24.1) when using MT alone, compared with substantial thrombus removal (62.0% +/- 24.9) when using MT after pharmacologic thrombolytic agents had been administered (P =.006).
The use of adjunctive MT to augment pharmacologic catheter-directed DVT thrombolysis provides comparable procedural success and may reduce the required thrombolytic dose and infusion duration.
评估辅助机械血栓切除术（MT）联合药物导管定向下肢静脉溶栓的应用效果。
1997年8月至2001年7月期间，采用辅助MT的导管定向溶栓治疗20例患者（22例手术）的28条有症状下肢的下肢深静脉血栓形成（DVT）。记录手术成功率、严重出血情况、溶栓输注时间和溶栓剂总剂量。
28条下肢中的23条（82%）手术成功。15例患者（18条下肢）接受了髂静脉支架置入术。22例手术中有3例（14%）出现严重出血，导致2例患者输血，第3例患者进行了子宫内膜消融术。平均每条下肢的输注时间为16.8小时±12.8小时。平均每条下肢的总剂量低于已发表的DVT溶栓研究报告中的剂量：尿激酶267万U±160万U，组织型纤溶酶原激活剂18.4mg±10.7mg，瑞替普酶13.8U±6.9U。静脉造影分析显示，单独使用MT时血栓清除率极低（26.0%±24.1%），而在给予药物溶栓剂后使用MT时血栓清除率较高（62.0%±24.9%）（P=0.006）。
辅助MT增强药物导管定向DVT溶栓的应用效果相当，且可能减少所需的溶栓剂量和输注持续时间。
