Ni Q H, Guo X J, Yang S F, Wang W L, Xue G H, Zhao Y P, Ye M, Zhang L
Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University,Shanghai 200127,China.
Zhonghua Yi Xue Za Zhi. 2022 Feb 22;102(7):486-490. doi: 10.3760/cma.j.cn112137-20210819-01886.
To evaluate the safety and clinical efficacy of percutaneous mechanical thrombectomy (PMT) through ipsilateral calf venous access in the treatment of entire-limb acute deep vein thrombosis (DVT). From July 2017 to August 2020, the clinical data of patients with entire-limb acute DVT at Renji Hospital, School of Medicine, Shanghai Jiaotong University treated by AngioJet through ipsilateral calf venous access were analyzed retrospectively. All patients received rivaroxaban or warfarin anticoagulant therapy for at least 6 months after operation. Pressure gradient socks were given routinely after operation. All patients were followed up at 3, 6, 12 months and every year after operation. The primary end points were the 12-month primary patency rate and the incidence of post thrombotic syndrome (PTS). The secondary end points included the thrombus clearance rate, total complication rate, bleeding complication rate and the 12-month incidence of moderate to severe PTS. A total of 31 patients were included in the study. The age ranged from 31 to 80 (63±14) years, including 16 males and 15 females, 23 left lower limb DVT and 8 right lower limb DVT. There were 15 cases treated through peroneal venous access, 6 cases through anterior tibial venous access and 10 cases through posterior tibial venous access. Moreover, 9 cases underwent combined catheter-directed thrombolysis, 25 cases underwent iliac vein percutaneous transluminal angioplasty (PTA), and 10 cases underwent iliac vein stenting. The thrombus clearance rate was grade Ⅱ in 19 cases (61.3%) and grade Ⅲ in 12 cases (38.7%). One patient (3.2%) with anterior tibial venous access developed hematoma at the puncture site, which was improved after pressure bandage, and there were no other bleeding and serious complications. All the 31 patients were followed up for at least 12 months, with an average follow-up period of (22±9) months. The 12-month primary patency rate was 77.4% (24/31). The 12-month incidence of PTS was 16.1% (5/31) and the incidence of moderate to severe PTS was 3.2% (1/31). PMT through ipsilateral calf venous access is safe and effective in the treatment of entire-limb acute DVT. Thrombus in the distal popliteal vein can be one-stage removed and the incidence of PTS is low. It is considered as the first choice of access for the endovascular treatment of entire-limb acute DVT.
评估经同侧小腿静脉入路行经皮机械血栓清除术（PMT）治疗全肢型急性深静脉血栓形成（DVT）的安全性和临床疗效。回顾性分析2017年7月至2020年8月上海交通大学医学院附属仁济医院采用AngioJet经同侧小腿静脉入路治疗的全肢型急性DVT患者的临床资料。所有患者术后均接受利伐沙班或华法林抗凝治疗至少6个月。术后常规给予压力梯度袜。所有患者术后3、6、12个月及每年进行随访。主要终点为12个月时的原发性通畅率和血栓形成后综合征（PTS）的发生率。次要终点包括血栓清除率、总并发症发生率、出血并发症发生率以及12个月时中重度PTS的发生率。本研究共纳入31例患者。年龄范围为31至80（63±14）岁，其中男性16例，女性15例，左下肢DVT 23例，右下肢DVT 8例。经腓静脉入路治疗15例，经胫前静脉入路治疗6例，经胫后静脉入路治疗10例。此外，9例患者接受了导管直接溶栓联合治疗，25例患者接受了髂静脉经皮腔内血管成形术（PTA），10例患者接受了髂静脉支架置入术。血栓清除率Ⅱ级19例（61.3%）；Ⅲ级12例（38.7%）。1例（3.2%）经胫前静脉入路患者穿刺部位出现血肿，经加压包扎后好转，无其他出血及严重并发症发生。31例患者均获得至少12个月的随访，平均随访时间为（22±9）个月。12个月时原发性通畅率为77.4%（24/31）。12个月时PTS发生率为16.1%（5/31），中重度PTS发生率为3.2%（1/31）。经同侧小腿静脉入路行PMT治疗全肢型急性DVT安全有效。腘静脉远端血栓可一期清除，PTS发生率低。可作为全肢型急性DVT血管内治疗的首选入路。
