Gombert Alexander, Gombert Ricarda, Barbati Mohammad E, Bruners Philipp, Keszei Andras, Wittens Cees, Jalaie Houman, Grommes Jochen
1 European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany.
2 Department of Anaesthesiology, Marienhospital Aachen, Aachen, Germany.
Phlebology. 2018 May;33(4):251-260. doi: 10.1177/0268355517697784. Epub 2017 Mar 16.
Purpose Studies on ultrasound-accelerated, catheter-directed thrombolysis of acute deep vein thrombosis emphasize good patency rates and low complication rates. Therefore, we analyzed quality of life besides technical success and patency in our patients after ultrasound-accelerated, catheter-directed thrombolysis. Methods Between 2009 and 2014, 42 patients suffering from iliofemoral deep vein thrombosis received ultrasound-accelerated, catheter-directed thrombolysis. Follow-up included clinical exanimation and ultrasound. Thirty patients (36 interventions), mean age 41.3 years (range 19-71 years), 56.6% women (17/30), completed the surveys. Five different scores were used to assess the quality of life and symptoms of postthrombotic syndrome: SF36, Euro-QOL 5D, PDI, VEINES-QOL/Sym, and the Villalta score. Results Mean therapy duration of ultrasound-accelerated, catheter-directed thrombolysis was 76.4 h and therapeutic success could be reported in 80.5% (29/36). Successful ultrasound-accelerated, catheter-directed thrombolysis was followed by stent angioplasty in 58.3% (21/36) procedures. Overall complication rate was 19.44%, mainly formed by minor bleedings. Mean follow-up was 38.5 months. The primary patency rate was 63.8%, the assisted-primary and the secondary patency rate were 80.5%. We observed an improved quality of life in our patients' cohort compared to patients suffering from postthrombotic syndrome. Conclusion Although ultrasound-accelerated, catheter-directed thrombolysis is feasible with good patency rates, further prospective randomized trials are necessary to evaluate the value of thrombus removal in iliofemoral deep vein thrombosis in comparison to conservative treatment.
目的 关于超声加速导管定向溶栓治疗急性深静脉血栓形成的研究强调了良好的通畅率和低并发症发生率。因此，我们在患者接受超声加速导管定向溶栓治疗后，除了分析技术成功率和通畅情况外，还对生活质量进行了分析。方法 2009年至2014年期间，42例患有髂股深静脉血栓形成的患者接受了超声加速导管定向溶栓治疗。随访包括临床检查和超声检查。30例患者（36次干预），平均年龄41.3岁（范围19 - 71岁），56.6%为女性（17/30），完成了调查。使用五个不同的评分来评估血栓形成后综合征的生活质量和症状：SF36、欧洲生活质量5维度量表（Euro - QOL 5D）、疼痛残疾指数（PDI）、静脉生活质量/症状量表（VEINES - QOL/Sym）和维拉塔评分。结果 超声加速导管定向溶栓治疗的平均持续时间为76.4小时，治疗成功率为80.5%（29/36）。在58.3%（21/36）的操作中，成功的超声加速导管定向溶栓治疗后进行了支架血管成形术。总体并发症发生率为19.44%，主要为轻微出血。平均随访时间为38.5个月。初始通畅率为63.8%，辅助初始通畅率和次级通畅率为80.5%。与患有血栓形成后综合征的患者相比，我们观察到我们的患者队列生活质量有所改善。结论 尽管超声加速导管定向溶栓治疗可行且通畅率良好，但与保守治疗相比，仍需要进一步的前瞻性随机试验来评估髂股深静脉血栓形成中血栓清除的价值。
