Martinez Trabal Jorge L, Comerota Anthony J, LaPorte Frankie B, Kazanjian Sahira, DiSalle Robert, Sepanski Deborah M
Section of Vascular Surgery, Jobst Vascular Center, The Toledo Hospital, Toledo, Ohio 43606, USA.
J Vasc Surg. 2008 Dec;48(6):1532-7. doi: 10.1016/j.jvs.2008.07.013. Epub 2008 Sep 19.
Early thrombus removal in patients with iliofemoral deep venous thrombosis (IFDVT) reduces postthrombotic morbidity. Preserving valve function and relieving venous obstruction prevents deterioration of quality of life and loss of economic potential. The preferred method for treating IFDVT is catheter-directed thrombolysis (CDT). Recently, isolated segmental pharmacomechanical thrombolysis (ISPMT) has emerged as a treatment option for patients with extensive IFDVT. The purpose of our study is to determine whether there are advantages to using ISPMT as the primary treatment for patients with iliofemoral IFDVT and, if so, to quantify those advantages relative to CDT.
Forty-three patients with IFDVT were treated with percutaneous CDT between May 2003 and June 2007. Twenty-one patients (27 limbs) were treated with CDT and 22 patients (25 limbs) were treated with ISPMT +/- CDT. Demographics, extent of thrombus, procedural details, and thrombus resolution were recorded.
Treatment time (55.4 vs 23.4 hours; P < .0001) and dose of rt-PA (59.3 vs 33.4 mg; P = .0009) were decreased and overall lytic success (60% vs 80%; P = .0016) increased with ISPMT. Adjunctive venoplasty and stenting, complications, hospital length-of-stay (LOS), and intensive care unit LOS were similar between groups.
ISPMT offers more effective thrombus removal in less time and with a reduced dose of thrombolytic agent. However, decreased treatment time did not translate into decreased hospital or ICU stay. Longer-term follow-up is required to determine whether improved thrombus resolution translates to better functional outcome and reduced postthrombotic morbidity.
髂股深静脉血栓形成（IFDVT）患者早期血栓清除可降低血栓形成后发病率。保留瓣膜功能和缓解静脉阻塞可防止生活质量下降和经济潜力丧失。治疗IFDVT的首选方法是导管定向溶栓（CDT）。最近，孤立节段性药物机械溶栓（ISPMT）已成为广泛IFDVT患者的一种治疗选择。我们研究的目的是确定将ISPMT作为髂股IFDVT患者的主要治疗方法是否具有优势，如果有，相对于CDT量化这些优势。
2003年5月至2007年6月期间，43例IFDVT患者接受了经皮CDT治疗。21例患者（27条肢体）接受CDT治疗，22例患者（25条肢体）接受ISPMT+/-CDT治疗。记录人口统计学、血栓范围、手术细节和血栓溶解情况。
ISPMT治疗时间（55.4小时对23.4小时；P<.0001）和rt-PA剂量（59.3毫克对33.4毫克；P=.0009）降低，总体溶栓成功率（60%对80%；P=.0016）提高。两组间辅助性静脉成形术和支架置入术、并发症、住院时间（LOS）和重症监护病房LOS相似。
ISPMT能在更短时间内以更低剂量的溶栓剂更有效地清除血栓。然而，治疗时间的缩短并未转化为住院或ICU住院时间的缩短。需要更长时间的随访来确定改善的血栓溶解是否能转化为更好的功能结果和降低血栓形成后发病率。
