Academic Department of Vascular Surgery, Cardiovascular Division, St. Thomas' Hospital, King's College London, UK.
Department of Interventional Radiology, Guys and St Thomas Hospital, London, UK.
Eur J Vasc Endovasc Surg. 2020 Oct;60(4):578-585. doi: 10.1016/j.ejvs.2020.05.006. Epub 2020 Jul 11.
Percutaneous thrombus removal is used for the treatment of iliofemoral deep vein thrombosis (DVT), but the efficacy of different treatment modalities has not yet been determined. The aim of this study was to compare the outcomes of patients treated with additional AngioJet pharmacomechanical thrombectomy (PCDT) vs. catheter directed lysis (CDT) alone.
A retrospective review of all patients who received thrombolysis for the treatment of symptomatic acute iliofemoral DVT between 2011 and 2017 was carried out. Outcome measures included the incidence of post-thrombotic syndrome (PTS), procedural outcomes (lytic exposure), the incidence of complications, and vessel patency. All patients were followed up for a minimum of one year.
A total of 151 limbs were treated, 70 limbs with PCDT and 81 limbs with CDT alone. Demographic data and prevalence of risk factors were comparable. Incidence of PTS (Villalta score at one year) showed no significant difference (22.2% PCDT vs. 24.7% CDT alone, p = .74). Use of PCDT resulted in a non-statistically significant trend for fewer bleeds (n = 4/63 [6.3%] vs. 13/76 [17.1%]; relative risk 0.37, 95% confidence interval [CI] 0.13-1.08; p = .07), a statistically significant reduction in lysis duration (40 h [95% CI 34-46] vs. 53 h [95% CI 49-58]; p < .001) and a reduction in lytic dose (49 mg [95% CI 42-55] vs. 57 mg [95% CI 52-61]; p = .011) compared with CDT. This reduction was accentuated in 24 cases primarily treated with AngioJet PowerPulse mode (27 h, 95% CI 20-34 [p < .001] and 42 mg, 95% CI 34-50 [p = .009]). Incidences of complications were comparable between groups, with one death due to an intracranial haemorrhage following CDT. Although the incidence of haemoglobinuria was increased following PCDT (12/63 [19.0%] vs. 3/76 [3.9%]; p = .006), no significant difference in acute kidney injury was observed (3/63 [4.8%] vs. 1/76 [1.3%]; p = .33). No significant difference in vessel patency over two years was observed (p = .73).
The use of PCDT for the treatment of iliofemoral DVT was observed to provide comparable patient outcomes, comparable vessel patency, an acceptable safety profile, and reduced overall lytic dose.
经皮血栓切除术用于治疗髂股深静脉血栓形成（DVT），但不同治疗方式的疗效尚未确定。本研究旨在比较联合应用 AngioJet 机械血栓切除术（PCDT）与单独导管定向溶栓（CDT）治疗患者的结局。
回顾性分析 2011 年至 2017 年期间接受溶栓治疗的症状性急性髂股 DVT 患者。主要观察终点包括深静脉血栓形成后综合征（PTS）的发生率、手术结果（溶栓暴露）、并发症发生率和血管通畅率。所有患者均至少随访 1 年。
共治疗了 151 条肢体，70 条肢体接受 PCDT，81 条肢体接受单独 CDT。两组患者的人口统计学数据和危险因素发生率无显著差异。（一年时的 Villalta 评分）PTS 发生率无显著差异（22.2% PCDT 与 24.7% 单独 CDT，p=0.74）。PCDT 的应用出血率呈非统计学显著降低（n=4/63 [6.3%] 与 13/76 [17.1%]；相对风险 0.37，95%置信区间 [CI] 0.13-1.08；p=0.07），溶栓时间显著缩短（40 小时 [95%CI 34-46] 与 53 小时 [95%CI 49-58]；p<0.001），溶栓剂量减少（49 毫克 [95%CI 42-55] 与 57 毫克 [95%CI 52-61]；p=0.011），与 CDT 相比。在主要采用 AngioJet PowerPulse 模式治疗的 24 例患者中，这种减少更为明显（27 小时，95%CI 20-34 [p<0.001] 和 42 毫克，95%CI 34-50 [p=0.009]）。两组并发症发生率相当，1 例因 CDT 后颅内出血死亡。尽管 PCDT 后血红蛋白尿发生率增加（12/63 [19.0%] 与 3/76 [3.9%]；p=0.006），但急性肾损伤无显著差异（3/63 [4.8%] 与 1/76 [1.3%]；p=0.33）。两年后血管通畅率无显著差异（p=0.73）。
PCDT 用于治疗髂股 DVT 可获得相似的患者结局、相似的血管通畅率、可接受的安全性和降低的整体溶栓剂量。
