Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, P.R. China.
J Thromb Thrombolysis. 2021 Apr;51(3):757-766. doi: 10.1007/s11239-020-02222-4.
The recent adjunctive catheter-directed thrombolysis (ATTRACT) trial rose a controversy about the treatment effect of catheter-directed thrombolysis (CDT) in deep venous thrombosis (DVT). In fact, most studies including the ATTRACT trial did not perform subgroup analysis of catheterization approaches. Different approaches would confound the conclusions. Therefore, a single-center retrospective analysis was performed to compare the differences between the antegrade (AGA) and retrograde (RGA) approaches. Total 217 DVT patients treated with CDT were enrolled from January 2010 to December 2017, with mean age of 55.3 years (67 received antegrade approach, 150 received retrograde approach). The clot burden reduction by segment was evaluated. The mean access establishment time and thrombolytic time were compared. The patency of the iliofemoral vein at 6 months was evaluated. The rate of PTS, quality of life and venous insufficiency were assessed at 1 year. AGA group showed better thrombolytic effect in popliteal and femoral vein than RGA group. The rate of iliofemoral clot burden reduction in RGA group was mostly at Grade II, while most were at Grade III in AGA group. The retrograde approach showed better thrombolysis effect in iliofemoral DVT than popliteal to iliac DVT. The RGA group reported longer mean access establishment time (5.4 ± 1.8 vs 27.0 ± 7.5 min, p < 0.001) and thrombolytic time (6.9 ± 1.5 days vs 6.8 ± 1.5 days, p = 0.586). At 6 months, RGA group had a lower rate of femoral vein patency (52.0% vs 89.6%, p < 0.001) and a higher rate of venous insufficiency (52.0% vs 29.9%, p < 0.001), compared with AGA group. Although there was no difference in the rate of PTS, the RGA group showed higher Villalta scores in the free and mild PTS. The antegrade approach was preferably recommended over the retrograde approach for CDT treatment.
最近的辅助性导管溶栓（ATTRACT）试验引发了关于导管溶栓（CDT）治疗深静脉血栓形成（DVT）效果的争议。实际上，大多数包括 ATTRACT 试验在内的研究并未对导管入路方法进行亚组分析。不同的方法会使结论复杂化。因此，进行了一项单中心回顾性分析，以比较顺行（AGA）和逆行（RGA）方法之间的差异。2010 年 1 月至 2017 年 12 月，共纳入 217 例接受 CDT 治疗的 DVT 患者，平均年龄为 55.3 岁（67 例接受顺行入路，150 例接受逆行入路）。评估了节段性血栓负荷减少情况。比较了平均置管建立时间和溶栓时间。评估了 6 个月时髂股静脉通畅情况。在 1 年时评估 PTS、生活质量和静脉功能不全的发生率。AGA 组在腘静脉和股静脉的溶栓效果优于 RGA 组。RGA 组髂股静脉血栓负荷减少的发生率主要为 II 级，而 AGA 组主要为 III 级。逆行入路在髂股 DVT 中的溶栓效果优于腘静脉至髂静脉 DVT。RGA 组的平均置管建立时间（5.4±1.8 分钟比 27.0±7.5 分钟，p<0.001）和溶栓时间（6.9±1.5 天比 6.8±1.5 天，p=0.586）较长。6 个月时，RGA 组股静脉通畅率（52.0%比 89.6%，p<0.001）较低，静脉功能不全率（52.0%比 29.9%，p<0.001）较高，与 AGA 组相比。虽然 PTS 发生率无差异，但 RGA 组的 Villalta 评分在自由性和轻度 PTS 中较高。CDT 治疗时，顺行入路优于逆行入路。
