Dumantepe Mert, Uyar Ibrahim
1 Department of Cardiovascular Surgery, Bahcesehir University, Istanbul, Turkey.
2 Department of Cardiovascular Surgery, Izmir Tepecik Training and Research Hospital, Izmir, Turkey.
Phlebology. 2018 Jul;33(6):388-396. doi: 10.1177/0268355517711792. Epub 2017 May 22.
Objective To evaluate the clinical safety and effectiveness of percutaneous rheolytic thrombectomy in patients with acute lower extremity deep venous thrombosis. Method Sixty-eight consecutive patients with acute massive lower extremity deep venous thrombosis were included in this retrospective study. A percutaneous rheolytic thrombectomy device (Angiojet ® Rheolytic thrombectomy catheter, Boston Scientific, Marlborough, MA, USA) was used in all patients in an angiography suite through ipsilateral popliteal vein access. Thrombus clearance and complications were evaluated. Furthermore, patients underwent a clinical evaluation according to a modified Villalta scale for the investigation of post thrombotic syndrome in follow-up. The Venous Clinical Severity Score, Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Sym questionnaires were completed preoperatively and readministered postoperatively. Results Overall thrombus clearance (complete recanalization was achieved in 58 patients (85.2%) and partial recanalization was achieved in 7 patients (10.2%) confirmed through venographic assessment was achieved in 95.5% of the patient population. The mean Venous Clinical Severity Score preoperatively was 13.1 ± 2.2 and decreased to 4.0 ± 1.3 postoperatively (P < 0.01). The Villalta scale dropped from 12.9 ± 2.8 to 5.5 ± 1.4 postoperatively (P < 0.001). Overall quality of life and symptoms improved as assessed by Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Sym (P < 0.01 and 0.02, respectively). Only three minor bleedings were seen but none of the patients suffered from major bleeding, symptomatic pulmonary embolism, death, or other procedure related complications. Fifty-nine out of 65 patients (90.7%) who were treated successfully with rheolytic thrombectomy remained patent at 12 months according to DUS and five patients (7.3%) developed a mild post thrombotic syndrome. Conclusion Rheolytic thrombectomy with or without stenting is superior to anticoagulant therapy alone in terms of both ensuring venous patency and improving clinical symptoms. This technique is a safe, effective and easily performed method of endovascular treatment with a low rate of major treatment complications and shows promising clinical mid-term results.
目的 评估经皮血栓消融术治疗急性下肢深静脉血栓形成患者的临床安全性和有效性。方法 本回顾性研究纳入68例连续性急性下肢大面积深静脉血栓形成患者。所有患者均在血管造影室通过同侧腘静脉入路使用经皮血栓消融装置（美国波士顿科学公司的Angiojet®血栓消融导管）。评估血栓清除情况及并发症。此外，患者在随访时根据改良Villalta量表进行临床评估，以调查血栓形成后综合征。术前及术后完成静脉临床严重程度评分、静脉功能不全流行病学和经济学研究-生活质量/症状问卷。结果 通过静脉造影评估，总体血栓清除率（58例患者（85.2%）实现完全再通，7例患者（10.2%）实现部分再通）在95.5%的患者中得以实现。术前静脉临床严重程度评分均值为13.1±2.2，术后降至4.0±1.3（P<0.01）。Villalta量表术后从12.9±2.8降至5.5±1.4（P<0.001）。根据静脉功能不全流行病学和经济学研究-生活质量/症状评估，总体生活质量和症状均有改善（分别为P<0.01和0.02）。仅观察到3例轻微出血，但无患者发生大出血、症状性肺栓塞、死亡或其他与手术相关的并发症。根据双功超声检查，65例成功接受血栓消融术治疗的患者中有59例（90.7%）在12个月时保持血管通畅，5例患者（7.3%）出现轻度血栓形成后综合征。结论 无论是否置入支架，血栓消融术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。该技术是一种安全、有效且易于实施的血管内治疗方法，主要治疗并发症发生率低，显示出良好的临床中期效果。
