Song Xiao-Jun, Liu Zhi-Li, Zeng Rong, Liu Chang-Wei, Ye Wei
Vascular surgery department, Peking Union Medical College Hospital, Beijing, China.
Vascular surgery department, Peking Union Medical College Hospital, Beijing, China.
Ann Vasc Surg. 2019 Jul;58:295-301. doi: 10.1016/j.avsg.2018.11.017. Epub 2019 Feb 13.
The aim of this study is to examine the efficacy and safety of AngioJet rheolytic thrombectomy for the treatment of subacute deep venous thrombosis (DVT) in lower limbs.
A retrospective study was performed on 90 patients with subacute DVT (15-90 days) in lower limbs in our center from November 2015 to December 2016. In total, 27 patients with subacute DVT in lower limbs treated with AngioJet rheolytic thrombectomy were included in the study, including 17 men and 10 women. The onset time of thrombosis was between 15 and 75 days. Five patients were diagnosed bilaterally; 5 patients were diagnosed in the right lower limb; and 17 patients were affected by thrombosis in left lower limb. All the 27 cases received AngioJet rheolytic thrombectomy.
After AngioJet thrombectomy, 17 cases were improved to grade II (50-99%), and 10 cases were grade I (<50%). Nineteen cases were treated with subsequent catheter-directed thrombolysis (CDT), and the average time of thrombolysis was 3.2 days, with an average urokinase administration dose of 7.32 million units. Among the 27 cases, 21 of them received iliac venous balloon dilation, with 10 of them being implanted with the iliac vein stent; 12 stents were implanted in total. Finally, the angiography suggested that 25 cases (92.6%) obtained a recanalization rate higher than grade II, and no serious complications occurred during the perioperative period. All patients were followed up regularly for 3 to 15 months, and 2 patients died from malignant tumor during the follow-up period. Twenty-three cases were followed up for more than 6 months; 17 cases finished 12-month follow-up. The primary patency rate at 6 and 12 months was 96.3% and 88.9%, respectively. The Villalta score of postoperative postthrombosis syndrome symptom at 6 and 12 months was 3.3 ± 2.8 and 3.5 ± 2.8, respectively.
It is safe and feasible to use the AngioJet rheolytic thrombectomy in the treatment of subacute DVT in lower limbs. In patients without high risk of bleeding, combination of AngioJet thrombectomy and CDT is an effective treatment to reduce the thrombus volume.
本研究旨在探讨AngioJet机械性血栓清除术治疗下肢亚急性深静脉血栓形成（DVT）的有效性和安全性。
对2015年11月至2016年12月在本中心就诊的90例下肢亚急性DVT（15 - 90天）患者进行回顾性研究。本研究共纳入27例接受AngioJet机械性血栓清除术治疗的下肢亚急性DVT患者，其中男性17例，女性10例。血栓形成的发病时间在15至75天之间。5例为双侧诊断；5例为右下肢诊断；17例为左下肢血栓形成。27例均接受AngioJet机械性血栓清除术。
AngioJet血栓清除术后，17例改善至Ⅱ级（50 - 99%），10例为Ⅰ级（<50%）。19例随后接受了导管直接溶栓（CDT）治疗，平均溶栓时间为3.2天，尿激酶平均给药剂量为732万单位。27例中，21例接受了髂静脉球囊扩张术，其中10例植入了髂静脉支架；共植入12枚支架。最后，血管造影显示25例（92.6%）再通率高于Ⅱ级，围手术期未发生严重并发症。所有患者均定期随访3至15个月，随访期间2例死于恶性肿瘤。23例随访超过6个月；17例完成12个月随访。6个月和12个月时的原发性通畅率分别为96.3%和88.9%。术后6个月和12个月时血栓形成后综合征症状的Villalta评分为分别为3.3±2.8和3.5±2.8。
AngioJet机械性血栓清除术治疗下肢亚急性DVT安全可行。对于无高出血风险的患者，AngioJet血栓清除术联合CDT是减少血栓体积的有效治疗方法。
