Saydam Onur, Serefli Deniz
Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, Izmir, Turkey.
Vascular. 2021 Apr;29(2):280-289. doi: 10.1177/1708538120943320. Epub 2020 Jul 26.
The purpose of this study was to assess the clinical features of phlegmasia cerulea dolens and present the treatment outcomes with rheolytic thrombectomy device.
From January 2014 and March 2019, 329 patients were diagnosed and hospitalized for acute iliofemoral deep vein thrombosis, and among those patients, seven patients diagnosed with lower extremity phlegmasia cerulea dolens were consecutively enrolled. Diagnosis of phlegmasia cerulea dolens was initially made on clinical findings followed by imaging with Doppler ultrasound. The rheolytic thrombectomy device was used in all patients with a combination of catheter-directed thrombolysis as an adjunctive therapy to facilitate more rapid thrombus clearance except for one patient who had a contraindication to the use of tissue plasminogen activator.
Seven patients (four men, three women; median age, 63 years, range 52-68 years) were included. One patient had a relative contradiction to thrombolysis due to history of coronary artery bypass graft surgery; all other patients underwent pharmaco-mechanical thrombectomy with power pulse mode. The upper limit of 480 s was completed in all patients, and this time was not exceeded to prevent hemolysis-related complications. Six Fr catheters were used in four (57.1%) patients, and 8 Fr catheters were used in three patients (42.9%). Mean thrombolytic infusion duration was 28 ± 6.2 h for patients who received tissue plasminogen activator. After catheter-directed thrombolysis, total radiological success was achieved in two patients, and partial radiologic success was achieved in five patients; however, in all seven patients, clinical success was achieved. The mean duration for complete regression of cyanosis was 18.9 ± 8.1 h. Although no patients required blood replacement, mean decreases in hemoglobin and hematocrit were 2.7 ± 1.37 g/dl and 6.42 ± 4.47%, respectively. Acute kidney injury developed in three patients (42.9%). One patient required continuous renal replacement therapy. No cardiac complication was observed. One (14.3%) patient died of ventilator-related pneumonia on postprocedural day 10. The median duration of intensive care unit stay and hospital stay were 72 h (min-max: 24-264 h) and six days (min-max: 5-33 days), respectively.
Rheolytic thrombectomy was less invasive and effective strategy for early stage phlegmasia cerulea dolens at creating rapid thrombus clearance to establish clinical success and facilitate more conservative management with catheter-directed thrombolysis.
本研究旨在评估股青肿的临床特征，并呈现使用血栓消融术装置的治疗效果。
2014年1月至2019年3月期间，329例患者因急性髂股深静脉血栓形成被诊断并住院，其中7例被诊断为下肢股青肿的患者被连续纳入研究。股青肿的诊断最初基于临床表现，随后通过多普勒超声成像进行确认。除1例有使用组织纤溶酶原激活剂禁忌证的患者外，所有患者均使用血栓消融术装置联合导管直接溶栓作为辅助治疗，以促进血栓更快清除。
纳入7例患者（4例男性，3例女性；中位年龄63岁，范围52 - 68岁）。1例患者因冠状动脉搭桥手术史存在溶栓相对禁忌证；所有其他患者均采用功率脉冲模式进行药物机械性血栓切除术。所有患者均在480秒的上限内完成操作，未超过此时间以预防溶血相关并发症。4例（57.1%）患者使用6F导管，3例患者（42.9%）使用8F导管。接受组织纤溶酶原激活剂治疗的患者平均溶栓输注持续时间为28±6.2小时。导管直接溶栓后，2例患者实现了完全影像学成功，5例患者实现了部分影像学成功；然而，所有7例患者均实现了临床成功。青紫完全消退的平均持续时间为18.9±8.1小时。虽然没有患者需要输血，但血红蛋白和血细胞比容平均分别下降了2.7±1.37 g/dl和6.42±4.47%。3例患者（42.9%）发生急性肾损伤。1例患者需要持续肾脏替代治疗。未观察到心脏并发症。1例（14.3%）患者在术后第10天死于呼吸机相关性肺炎。重症监护病房住院时间和住院时间的中位数分别为72小时（最小值 - 最大值：24 - 264小时）和6天（最小值 - 最大值：5 - 33天）。
血栓消融术是治疗早期股青肿的一种侵入性较小且有效的策略，能够快速清除血栓以实现临床成功，并便于采用更保守的导管直接溶栓治疗。
