Plate G, Akesson H, Einarsson E, Ohlin P, Eklöf B
Department of Surgery, Central Hospital, Helsingborg, Sweden.
Eur J Vasc Surg. 1990 Oct;4(5):483-9. doi: 10.1016/s0950-821x(05)80788-1.
Forty-one patients with acute iliofemoral venous thrombosis were randomised to conventional anticoagulation or acute thrombectomy combined with a temporary arterio-venous fistula (AVF) and anti-coagulation. Follow-up after 5 years in 22 medical and 19 surgical patients revealed slightly more asymptomatic patients (37 vs. 18%) and less frequent severe post-thrombotic sequelae (16 vs. 27%) in the surgical group (N.S.). The iliac vein was more frequently (P less than 0.05) normal following thrombectomy (71 vs. 30%) as demonstrated by radionuclide angiography, but occlusion plethysmography showed an outflow capacity (61 vs. 45 ml/min/100 ml) that was not significantly better. There was no obvious difference in muscle pump function (EVrel) and reflux (Q/EVrel) assessed by foot volumetry. Still, the ambulatory venous pressure was significantly (P less than 0.05) lower in the surgical group. There was a tendency towards better results following thrombectomy in patients with fresh thrombosis and a successful initial procedure. Although the numbers of observations in many cases were too small to provide statistical evidence of benefit with venous thrombectomy + AVF, this procedure seems to improve the long-term outcome following acute iliofemoral venous thrombosis. Since the difference in outcome is not very striking, anticoagulation treatment is still an acceptable alternative.
41例急性髂股静脉血栓形成患者被随机分为常规抗凝组或急性血栓切除术联合临时性动静脉瘘（AVF）及抗凝组。对22例接受内科治疗和19例接受外科治疗的患者进行5年随访后发现，外科治疗组无症状患者略多（37%对18%），血栓形成后严重后遗症的发生率较低（16%对27%）（无统计学差异）。放射性核素血管造影显示，血栓切除术后髂静脉恢复正常的情况更为常见（P<0.05）（71%对30%），但闭塞体积描记法显示流出能力（61对45 ml/min/100 ml）并无显著改善。通过足部容积测量法评估的肌肉泵功能（EVrel）和反流（Q/EVrel）没有明显差异。不过，外科治疗组的动态静脉压显著较低（P<0.05）。对于新鲜血栓形成且初始手术成功的患者，血栓切除术后有取得更好结果的趋势。虽然在许多情况下观察数量过少，无法提供静脉血栓切除术+AVF有益的统计学证据，但该手术似乎可改善急性髂股静脉血栓形成后的长期预后。由于结果差异不是非常显著，抗凝治疗仍是一种可接受的选择。
