Kuo Tzu-Ting, Huang Chun-Yang, Hsu Chiao-Po, Lee Chiu-Yang
Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Division of Cardiovascular Surgery, Far East Memorial Hospital, New Taipei City, Taiwan, ROC.
J Chin Med Assoc. 2017 Feb;80(2):72-79. doi: 10.1016/j.jcma.2016.08.012. Epub 2016 Dec 23.
Aggressive and early thrombus removal strategy has been widely used as a treatment for iliofemoral deep vein thrombosis (DVT). We compared the long-tem venous outcome, including postthrombotic syndrome (PTS), in patients undergoing catheter-directed thrombolysis (CDT) and pharmacomechanical thrombectomy (PMT).
From January 2009 to December 2013, 61 patients with acute proximal DVT were enrolled in this prospective study. Thirty-one patients underwent CDT and 30 patients underwent PMT, and each patient was followed for at least 2 years after treatment. Observations included venous outflow resistance, venous insufficiency, thrombus score (TS), severity of PTS, and surgical complications.
Venous outflow obstruction was similar in the CDT and PMT groups (32.3% vs. 30.0%, p = 0.695), and venous insufficiency of each group was 38.7% and 30.0% (p = 0.774), respectively. The TS at 24 months of each group showed no significant difference (0.90 vs. 0.70, p = 0.526). The mean Villalta scale scores of the CDT and PMT groups were 3.13 and 1.87, respectively (p = 0.042). Patients without PTS had significantly lower TS since 1 week postoperatively (1.59 vs. 4.60, p < 0.001). The severity of PTS was highly correlated with the TS, rate of thrombolysis, and severity of obstruction, and was moderately correlated with the venous registry index and reflux severity.
CDT and PMT have similar venous outcomes in patients with acute iliofemoral DVT, although PTS is less severe following PMT than after CDT. We propose that early and thorough removal of thrombus, using either CDT or PMT, is beneficial to prevent PTS.
积极的早期血栓清除策略已被广泛用于治疗髂股深静脉血栓形成（DVT）。我们比较了接受导管定向溶栓（CDT）和药物机械性血栓切除术（PMT）的患者的长期静脉结局，包括血栓形成后综合征（PTS）。
2009年1月至2013年12月，61例急性近端DVT患者纳入本前瞻性研究。31例患者接受CDT，30例患者接受PMT，每位患者在治疗后至少随访2年。观察指标包括静脉流出阻力、静脉功能不全、血栓评分（TS）、PTS严重程度和手术并发症。
CDT组和PMT组的静脉流出道梗阻情况相似（32.3%对30.0%，p = 0.695），每组的静脉功能不全发生率分别为38.7%和30.0%（p = 0.774）。每组24个月时的TS无显著差异（0.90对0.70，p = 0.526）。CDT组和PMT组的平均Villalta量表评分分别为3.13和1.87（p = 0.042）。术后1周起，无PTS的患者TS显著更低（1.59对4.60，p < 0.001）。PTS的严重程度与TS、溶栓率和梗阻严重程度高度相关，与静脉登记指数和反流严重程度中度相关。
CDT和PMT在急性髂股DVT患者中的静脉结局相似，尽管PMT后的PTS比CDT后轻。我们建议，使用CDT或PMT早期彻底清除血栓有利于预防PTS。
