Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
Ann Vasc Surg. 2021 Aug;75:275-279. doi: 10.1016/j.avsg.2021.03.015. Epub 2021 Apr 4.
The objective of this study is to examine factors associated with thrombus extension after early experience with mechanochemical ablation, which combines mechanical damage to the venous endothelium with infusion of a sclerosant.
A retrospective review was performed of patients who underwent mechanochemical ablation to treat saphenous vein insufficiency in the thigh including the saphenofemoral junction. Data abstracted included patient demographics, procedural details, and postprocedural outcomes. Thrombus extension was determined by postprocedural duplex ultrasound and classified as flush closure with the femoral vein and any extension of thrombus into the femoral vein.
Seventy-three patients met inclusion criteria. The mean age of the population was 60, 17.8% were female, and the mean body mass index (BMI) was 30.7. Seven (9.6%) patients who underwent mechanochemical ablation experienced saphenous vein closure flush with the femoral vein. Eleven (15%) patients experience extension of thrombus to less than 50% of the diameter of the femoral vein and one patient experienced complete thrombosis of the femoral vein. There was no significant difference in age, sex, or comprehensive classification system for chronic venous disorders between the group with thrombus extension and the group without, with the exception of BMI. The mean BMI in the group with thrombus extension was 26.8 vs. 32 in the group without (P = 0.02). There was no significant difference between the 2 groups in sclerosant volume used, distance between catheter tip and SFJ, and mean diameter of GSV in the thigh.
In this cohort, the incidence of thrombus extension into the femoral vein with mechanochemical ablation was high relative to rates of thrombus extension associated with reported rates of thermal ablation. Further investigation with larger cohorts, and standardized reporting is required to characterize the true rate of thrombus extension after mechanochemical ablation and identify maneuvers which may prevent thrombus extension.
本研究旨在探讨机械化学消融术后血栓延伸的相关因素，该方法将静脉内皮的机械损伤与硬化剂输注相结合。
对接受机械化学消融术治疗大腿包括股隐静脉在内的隐静脉功能不全的患者进行回顾性分析。提取的数据包括患者的人口统计学资料、手术细节和术后结果。血栓延伸通过术后双功能超声确定，并分为与股静脉平齐的完全闭塞和任何程度的血栓延伸至股静脉。
73 例患者符合纳入标准。该人群的平均年龄为 60 岁，17.8%为女性，平均体重指数（BMI）为 30.7。7 例（9.6%）接受机械化学消融术的患者股隐静脉平齐于股静脉。11 例（15%）患者的血栓延伸至股静脉直径的不到 50%，1 例患者出现股静脉完全血栓形成。在血栓延伸组和无血栓延伸组之间，除 BMI 外，在年龄、性别或慢性静脉疾病综合分类系统方面无显著差异。血栓延伸组的平均 BMI 为 26.8，无血栓延伸组为 32（P=0.02）。在使用硬化剂体积、导管尖端与 SFJ 之间的距离以及股静脉在大腿中的平均直径方面，两组之间无显著差异。
在本队列中，与热消融相关的血栓延伸率相比，机械化学消融术后血栓延伸至股静脉的发生率较高。需要进一步对更大的队列进行研究，并采用标准化报告来描述机械化学消融术后血栓延伸的真实发生率，并确定可能预防血栓延伸的操作。
