急性深静脉血栓形成后的再通率：一项使用新提出的静脉直径变化指数的单中心经验。

Recanalization rates after acute deep vein thrombosis: a single-center experience using a newly proposed vein diameter variation index.

作者信息

Brandão Gustavo M S, Sobreira Marcone L, Malgor Rafael D, Rollo Hamilton A

机构信息

Department of Vascular Surgery, Botucatu School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.

出版信息

Ann Vasc Surg. 2014 Oct;28(7):1751-60. doi: 10.1016/j.avsg.2014.05.013. Epub 2014 Jun 6.

DOI:10.1016/j.avsg.2014.05.013

PMID:24911802

Abstract

BACKGROUND

Duplex ultrasound scanning (DUS) is the method of choice for diagnosis of deep vein thrombosis (DVT). However, only a few studies have performed prospective serial DUS after an acute episode of DVT to assess its evolution. This study aimed to report our experience using DUS combined with a thrombosis score (TS) and a newly proposed vein diameter variation index (VDVI) to evaluate the rate of resolution of DVT by assessing and quantifying the early stages of vein recanalization in proximal vein segments within 6 months after an episode of acute lower extremity DVT.

METHODS

Twelve patients with first episode of acute lower extremity DVT confirmed by DUS as occurring in ≤10 days after the onset of venous thrombosis symptoms were followed up prospectively for 6 months. TS and VDVI were calculated at 1, 3, and 6 months to assess vein recanalization. Intra-thrombus arteriovenous fistula formation was also investigated and related to the recanalization process.

RESULTS

Seven (58%) women were included, with a total cohort median age of 53.5 ± 19 years. The left lower extremity was affected in 7 (58%) patients. DVT was diagnosed in 55 proximal vein segments. All patients had proximal DVT, with involvement of the external iliac, femoral, and popliteal veins. After 6 months, there was a significant decrease in TS and increase in VDVI (P < 0.001) in all proximal vein segments assessed, indicating thrombus regression. The more distal the DVT was, the faster was the VDVI increase, with most popliteal veins being recanalized at 3 months (P < 0.001). Intra-thrombus arteriovenous fistula was identified in 50% of patients at 1 month while on anticoagulation.

CONCLUSIONS

The combined use of two different DUS-based assessment tools, TS and the proposed VDVI, provided an effective method to prospectively assess vein recanalization rates after an episode of acute lower extremity DVT in this series of patients and may allow a correct evaluation of DVT and its resolution or progression.

摘要

背景

双功超声扫描（DUS）是诊断深静脉血栓形成（DVT）的首选方法。然而，仅有少数研究在DVT急性发作后进行前瞻性系列DUS检查以评估其演变情况。本研究旨在报告我们使用DUS联合血栓形成评分（TS）和新提出的静脉直径变化指数（VDVI），通过评估和量化急性下肢DVT发作后6个月内近端静脉段静脉再通的早期阶段，来评估DVT溶解率的经验。

方法

12例首次发作的急性下肢DVT患者，经DUS确诊为静脉血栓形成症状发作后≤10天内发病，前瞻性随访6个月。在1、3和6个月时计算TS和VDVI以评估静脉再通情况。还研究了血栓内动静脉瘘的形成及其与再通过程的关系。

结果

纳入7名（58%）女性，全队列中位年龄为53.5±19岁。7名（58%）患者左下肢受累。55个近端静脉段诊断为DVT。所有患者均有近端DVT，累及髂外静脉、股静脉和腘静脉。6个月后，所有评估的近端静脉段TS显著降低，VDVI升高（P<0.001），表明血栓消退。DVT越靠近远端，VDVI升高越快，大多数腘静脉在3个月时再通（P<0.001）。1个月时，50%接受抗凝治疗的患者发现血栓内动静脉瘘。