Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China.
Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China.
Eur J Vasc Endovasc Surg. 2017 Oct;54(4):504-512. doi: 10.1016/j.ejvs.2017.06.025. Epub 2017 Aug 8.
OBJECTIVE/BACKGROUND: The objective was to assess the mid-term results of pharmacomechanical catheter-directed thrombolysis (PCDT) for symptomatic acute and subacute inferior vena cava (IVC) thrombosis; the risk factors of early thrombosis recurrence and iliocaval patency were also evaluated.
From January 2010 to December 2015, 54 patients (33 men; mean age 47.1 years) with symptomatic acute and subacute IVC thrombosis were treated with PCDT. Primary technical success (clot lysis ≥ 50% after PCDT), stent-assisted technical success (residual stenosis < 30% after stenting), clinical success (freedom from thrombosis recurrence within 30 days), complications, frequency of post-thrombotic syndrome (PTS; Villalta score ≥ 5), and iliocaval patency were recorded at follow-up evaluation. A multivariate regression model was used to determine predictors of early thrombosis reoccurrence and iliocaval patency.
The primary technical success and the stent-assisted technical success were 63% (n = 34/54) and 100% (n = 54/54) respectively. There were 11 patients (20%) with immediate recurrent thrombosis requiring repeat PCDT. Minor bleeding complications occurred in seven patients, and one patient with major bleeding needed a blood transfusion. The occurrence of PTS at a mean of 26 months (range 1-60 months) was 13% (7/54). The 3-year primary and secondary iliocaval patency was 63% and 81%, respectively. On multivariate analysis, active malignancy was predictive of immediate IVC thrombosis recurrence (hazard ratio [HR] 5.8, 95% confidence interval [CI] 1.7-19.8; p = .01), whereas the pre-existing filter played a protective role against iliocaval re-occlusion (HR 0.3, 95% CI 0.1-0.8; p = .01).
PCDT is safe and effective in managing symptomatic acute and subacute IVC thrombosis. Active malignancy is predictor of thrombosis re-occurrence, whereas the presence of a filter is associated with a higher rate of iliocaval patency at mid-term follow-up.
目的/背景：本研究旨在评估药物机械性导管溶栓（PCDT）治疗症状性急性和亚急性下腔静脉（IVC）血栓形成的中期结果；还评估了早期血栓复发和腔静脉通畅的危险因素。
2010 年 1 月至 2015 年 12 月，54 例（33 例男性；平均年龄 47.1 岁）症状性急性和亚急性 IVC 血栓形成患者接受了 PCDT 治疗。记录主要技术成功（PCDT 后血栓溶解≥50%）、支架辅助技术成功（支架置入后残余狭窄＜30%）、临床成功（30 天内无血栓复发）、并发症、血栓后综合征（PTS；Villalta 评分≥5）的发生频率以及腔静脉通畅情况。采用多变量回归模型确定早期血栓再发和腔静脉通畅的预测因素。
主要技术成功率和支架辅助技术成功率分别为 63%（n=34/54）和 100%（n=54/54）。11 例（20%）患者即刻复发血栓，需要重复 PCDT。7 例患者出现轻微出血并发症，1 例大出血患者需要输血。平均 26 个月（1-60 个月）时，PTS 的发生率为 13%（7/54）。3 年原发性和继发性腔静脉通畅率分别为 63%和 81%。多变量分析显示，活动性恶性肿瘤是即刻 IVC 血栓复发的预测因素（风险比 [HR] 5.8，95%置信区间 [CI] 1.7-19.8；p=0.01），而先前存在的滤器对腔静脉再闭塞具有保护作用（HR 0.3，95%CI 0.1-0.8；p=0.01）。
PCDT 治疗症状性急性和亚急性 IVC 血栓形成是安全有效的。活动性恶性肿瘤是血栓复发的预测因素，而滤器的存在与中期随访时更高的腔静脉通畅率相关。
