Cakir Volkan, Gulcu Aytac, Akay Emrah, Capar Ahmet E, Gencpinar Tugra, Kucuk Banu, Karabay Ozalp, Goktay A Yigit
Ataturk Training and Research Hospital, Department of Radiology, Division of İnterventional Radiology, Katip Celebi University, Izmir, Turkey,
Cardiovasc Intervent Radiol. 2014 Aug;37(4):969-76. doi: 10.1007/s00270-014-0925-y. Epub 2014 Jun 17.
The purpose of this study was to compare the efficacy of percutaneous aspiration thrombectomy (PAT) followed by standard anticoagulant therapy, with anticoagulation therapy alone, for the treatment of acute proximal lower extremity deep vein thrombosis.
In this randomised, prospective study, 42 patients with acute proximal iliofemoral deep vein thrombosis documented via Doppler ultrasound examination, were separated into an interventional treatment group (16 males, 5 females, average age 51 years) and a medical treatment group (13 males, 8 females, average age 59 years). In the interventional group, PAT with large-lumen 9-F diameter catheterisation was applied, after initiation of standard anticoagulant therapy. Balloon angioplasty (n 19) and stent implementation (n: 14) were used to treat patients with residual stenosis (>50 %) after PAT. Prophylactic IVC filters were placed in two patients. The thrombus clearance status of the venous system was evaluated by venography. In both the medical and interventional groups, venous patency rates and clinical symptom scores were evaluated at months 1, 3, and 12 after treatment.
Deep venous systems became totally cleared of thrombi in 12 patients treated with PAT. The venous patency rates in month 12 were 57.1 and 4.76 % in the interventional and medical treatment groups, respectively. A statistically significant improvement was observed in clinical symptom scores of the interventional group (PAT) with or without stenting (4.23 ± 0.51 before treatment; 0.81 ± 0.92 at month 12) compared with the medical treatment group (4.00 ± 0.63 before treatment; 2.43 ± 0.67 at month 12). During follow-up, four patients in the medical treatment and one in the interventional group developed pulmonary embolisms.
For treatment of acute deep vein thrombosis, PAT with or without stenting is superior to anticoagulant therapy alone in terms of both ensuring venous patency and improving clinical symptoms. PAT is a safe, inexpensive, and easily performed method of endovascular treatment with a low rate of major complications. Our present findings and literature data suggest that PAT can be used as first-line treatment in proximal deep vein thrombosis patients, especially when thrombolytic treatment is contraindicated.
本研究旨在比较经皮抽吸血栓切除术（PAT）联合标准抗凝治疗与单纯抗凝治疗对急性下肢近端深静脉血栓形成的疗效。
在这项随机、前瞻性研究中，42例经多普勒超声检查确诊为急性髂股近端深静脉血栓形成的患者被分为介入治疗组（男16例，女5例，平均年龄51岁）和药物治疗组（男13例，女8例，平均年龄59岁）。介入组在开始标准抗凝治疗后，采用大口径9F导管进行PAT。对PAT后残留狭窄（>50%）的患者采用球囊血管成形术（19例）和支架置入术（14例）治疗。2例患者放置了预防性下腔静脉滤器。通过静脉造影评估静脉系统的血栓清除情况。在药物治疗组和介入治疗组中，分别在治疗后1、3和12个月评估静脉通畅率和临床症状评分。
12例接受PAT治疗的患者深静脉系统血栓完全清除。介入治疗组和药物治疗组在第12个月时的静脉通畅率分别为57.1%和4.76%。与药物治疗组（治疗前4.00±0.63；第12个月时2.43±0.67）相比，介入治疗组（PAT）无论是否置入支架，其临床症状评分均有统计学意义的改善（治疗前4.23±0.51；第12个月时0.81±0.92）。随访期间，药物治疗组有4例患者和介入治疗组有1例患者发生肺栓塞。
对于急性深静脉血栓形成的治疗，无论是否置入支架，PAT在确保静脉通畅和改善临床症状方面均优于单纯抗凝治疗。PAT是一种安全、廉价且易于实施的血管内治疗方法，主要并发症发生率低。我们目前的研究结果和文献数据表明，PAT可作为近端深静脉血栓形成患者的一线治疗方法，尤其是在溶栓治疗禁忌时。
