Department of Surgery, Vascular Surgery Division, St. Luke's Memorial Hospital, Ponce Health Sciences University, Ponce, Puerto Rico.
Department of Surgery, Vascular Surgery Division, St. Luke's Memorial Hospital, Ponce Health Sciences University, Ponce, Puerto Rico.
J Vasc Surg Venous Lymphat Disord. 2017 Mar;5(2):177-184. doi: 10.1016/j.jvsv.2016.09.008. Epub 2017 Jan 12.
Hybrid operative thrombectomy (HOT) is a novel technique for the treatment of acute iliofemoral deep venous thrombosis (IFDVT) and is an alternative to percutaneous techniques (PTs) that use thrombolytics. In this study, we compare perioperative and intermediate outcomes of HOT vs PT as interventions for early thrombus removal.
From July 2008 to May 2015, there were 71 consecutive patients who were treated with either PT (n = 31) or HOT (n = 40) for acute or subacute single-limb IFDVT. HOT consisted of surgical thrombectomy with balloon angioplasty with or without stenting by a single incision and fluoroscopically guided retrograde valve manipulation to extract the thrombus. PT included catheter-directed thrombolysis with or without pharmacomechanical thrombectomy using the Trellis-8 system (Bacchus Vascular, Santa Clara, Calif). Patients who presented with bilateral DVT (n = 4), inferior vena cava involvement (n = 8), or venous gangrene (n = 1) were excluded. Perioperative outcomes, quality measures, and thrombus resolution were compared between the two treatment groups. Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification, Villalta score, and venous duplex ultrasound at intermediate follow-up were also analyzed.
The left limb was the most common site of the IFDVT overall. Technical success (≥50% resolution) was 100% for both groups, and >80% resolution was achieved in all patients treated with HOT. There were eight major bleeding events in the PT group compared with three in the HOT group (P = .04). PT patients had a significantly longer length of stay (13 vs 10 days; P = .028) compared with HOT. At 2-year duplex ultrasound examination, there was no difference between HOT and PT in mean reflux times at the femoral-popliteal segment. At 2 years, 85% and 87% of the patients (HOT vs PT, respectively) had not developed post-thrombotic syndrome, and there was no difference between the groups for mean Villalta score (2.1 ± 1.9 vs 2.3 ± 2; P = .79).
PT and HOT have demonstrated good outcomes in the perioperative and intermediate periods. HOT is noninferior to PT as a technique for early thrombus removal and has the advantages that thrombus resolution is established in one operation and length of stay is significantly decreased. HOT avoids thrombolytic therapy, which may reduce major bleeding events.
杂交手术血栓切除术（HOT）是一种治疗急性髂股深静脉血栓形成（IFDVT）的新方法，是一种替代经皮技术（PT）的方法，后者使用溶栓药物。本研究比较 HOT 与 PT 作为早期血栓清除术的干预措施的围手术期和中期结果。
从 2008 年 7 月至 2015 年 5 月，共有 71 例急性或亚急性单肢 IFDVT 患者分别接受 PT（n=31）或 HOT（n=40）治疗。HOT 包括通过单一切口进行手术血栓切除术，联合球囊血管成形术和/或支架置入术，并经放射引导逆行瓣膜操作提取血栓。PT 包括经导管溶栓术，联合或不联合 Trellis-8 系统（Bacchus Vascular，Santa Clara，Calif）的药物机械血栓切除术。排除双侧 DVT（n=4）、下腔静脉受累（n=8）或静脉坏疽（n=1）的患者。比较两组患者的围手术期结局、质量指标和血栓溶解情况。还分析了中期随访时的临床、病因、解剖和病理生理学（CEAP）分类、Villalta 评分和静脉双功超声检查。
IFDVT 总体上最常见的部位是左下肢。两组的技术成功率（≥50%的溶解）均为 100%，所有接受 HOT 治疗的患者均实现了>80%的溶解。PT 组有 8 例大出血事件，而 HOT 组有 3 例（P=0.04）。与 HOT 组相比，PT 组患者的住院时间明显更长（13 天比 10 天；P=0.028）。在 2 年的静脉双功超声检查中，HOT 和 PT 在股-腘段平均反流时间方面没有差异。2 年时，HOT 和 PT 组分别有 85%和 87%的患者（HOT 与 PT 组）未发生血栓后综合征，两组间平均 Villalta 评分无差异（2.1±1.9 比 2.3±2；P=0.79）。
PT 和 HOT 在围手术期和中期均表现出良好的结果。HOT 在早期血栓清除方面不劣于 PT，并且具有血栓溶解在一次手术中建立且住院时间明显缩短的优势。HOT 避免了溶栓治疗，这可能会降低大出血事件的发生风险。
