de Kleijn Robert J C M F, Schropp Ludo, Westerink Jan, de Borst Gert J, Petri Bart-Jeroen
Department of Vascular Surgery, University Medical Center, Utrecht, the Netherlands.
Department of Vascular Medicine, University Medical Center, Utrecht, the Netherlands.
Ann Vasc Surg. 2020 Jul;66:654-661. doi: 10.1016/j.avsg.2020.01.083. Epub 2020 Feb 6.
The optimal timing of decompression surgery after thrombolysis in patients with primary upper extremity deep vein thrombosis (UEDVT) is still a matter of debate. This systematic review compares the safety and efficacy of early intervention versus postponed intervention in patients with primary UEDVT.
A structured PUBMED, EMBASE, and COCHRANE search was performed for studies reporting on the timing of surgical intervention for primary UEDVT. Studies reporting on timing of decompression surgery in combination with recurrent thrombosis, bleeding complications, and symptom-free survival were included. Two treatment groups were defined; group A received surgical decompression within two weeks after thrombolysis and group B after two weeks or more. All end points were assessed in accordance with the reported outcomes in the included articles. Mean percentages were calculated using descriptive statistics.
Six articles (126 patients) were included: 87 patients in group A versus 39 in group B. In group A, bleeding complications occurred in 7% of patients versus 5% in group B. Two-third of the bleeding complications in group A occurred in patients receiving surgical decompression within 24 hr after thrombolysis while kept on intravenous heparin both preoperatively and postoperatively. Reported preoperative recurrent thrombosis was 7% in group A versus 11% in group B, another 13% had postoperative recurrent thrombosis versus 21% in group B. The effectiveness of both treatment strategies was comparable with a total of 89% of patients in group A with minimal or no symptoms at final follow-up compared with 90% in group B. The mean follow-up in group A was 35 months (1-168 months) and 28 months (1-168 months) in group B.
Based on the limited available data presented in this review, early decompression surgery within two weeks after catheter-directed thrombolysis seems as safe and effective as postponed surgical intervention in patients with primary UEDVT.
原发性上肢深静脉血栓形成（UEDVT）患者溶栓后减压手术的最佳时机仍存在争议。本系统评价比较了原发性UEDVT患者早期干预与延迟干预的安全性和有效性。
对PUBMED、EMBASE和COCHRANE进行结构化检索，以查找报告原发性UEDVT手术干预时机的研究。纳入报告减压手术时机与复发性血栓形成、出血并发症和无症状生存期相关的研究。定义了两个治疗组；A组在溶栓后两周内接受手术减压，B组在两周或更长时间后接受手术减压。所有终点均根据纳入文章中报告的结果进行评估。使用描述性统计计算平均百分比。
纳入6篇文章（126例患者）：A组87例，B组39例。A组7%的患者发生出血并发症，B组为5%。A组三分之二的出血并发症发生在溶栓后24小时内接受手术减压且术前和术后均持续静脉注射肝素的患者中。报告的术前复发性血栓形成率A组为7%，B组为11%，另有13%的患者术后发生复发性血栓形成，B组为21%。两种治疗策略的有效性相当，A组共有89%的患者在最终随访时症状轻微或无症状，B组为90%。A组的平均随访时间为35个月（1 - 168个月），B组为28个月（1 - 168个月）。
基于本评价中有限的可用数据，对于原发性UEDVT患者，导管直接溶栓后两周内进行早期减压手术似乎与延迟手术干预一样安全有效。
