Nie Menglin, Fu Jian, Sun Jianming, Wang Haiyang
Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
J Endovasc Ther. 2023 Apr;30(2):250-258. doi: 10.1177/15266028221079773. Epub 2022 Mar 1.
To investigate the efficacy, safety, and mid-term outcomes of percutaneous mechanical thrombectomy (PMT) for acute symptomatic iliofemoral deep venous thrombosis (DVT) patients with recent (within 4 weeks) aneurysmal subarachnoid hemorrhage (aSAH).
From January 2016 to February 2020, 11 acute symptomatic iliofemoral DVT patients with a recent history of aSAH were enrolled in this study. All patients had a history of aneurysm ligation or clipping previously, computed tomography (CT) scans revealed ventricular hemorrhage had been absorbed obviously and no residual aneurysm. The mean time of DVT onset after aSAH ictus was 19.2±4.5 days, and the mean Glasgow score was 6.8 ± 0.7 (range, 6-8). These patients underwent PMT with an 8 French AspirexS device (Straub Medical AG, Wangs, Switzerland), subsequent stenting was performed to relieve the underlying stenosis, followed by anticoagulation alone. The procedure-related complications were assessed after intervention. The follow-ups were conducted up to 1 year, the patency was evaluated via duplex ultrasonography, and the incidence of post-thrombotic syndrome (PTS) was evaluated using the Villalta scale.
Grade III (>90%) clearance was achieved in all 11 patients. Stenting was performed in 7 patients (63.6%). There were no cerebral rebleeding events or other severe complications except 1 puncture site bleeding during treatment. A total of 90.9% (10 of 11) of patients were alive at the 12 month follow-up, and 7 patients achieved a good functional outcome. At the 1 year follow-up, there was 1 patient (10%) with mild PTS. The ultrasound showed that the patency of the iliofemoral veins was 100%, and femoral valvular incompetence was observed in 1 patient.
Percutaneous mechanical thrombectomy seems to be a feasible and safe treatment for acute iliofemoral DVT in selected patients with recent aSAH, and it shows promising results in restoring patency and reducing the risk of PTS.
探讨经皮机械血栓切除术（PMT）治疗近期（4周内）发生动脉瘤性蛛网膜下腔出血（aSAH）的急性症状性髂股深静脉血栓形成（DVT）患者的疗效、安全性及中期结局。
2016年1月至2020年2月，11例近期有aSAH病史的急性症状性髂股DVT患者纳入本研究。所有患者既往均有动脉瘤结扎或夹闭史，计算机断层扫描（CT）显示脑室出血已明显吸收且无残留动脉瘤。aSAH发作后DVT发病的平均时间为19.2±4.5天，格拉斯哥评分平均为6.8±0.7（范围6 - 8）。这些患者使用8F AspirexS装置（瑞士王斯市Straub Medical AG公司）进行PMT，随后进行支架置入以缓解潜在狭窄，之后仅进行抗凝治疗。干预后评估与手术相关的并发症。随访至1年，通过双功超声评估通畅情况，使用Villalta量表评估血栓形成后综合征（PTS）的发生率。
11例患者均实现III级（>90%）清除。7例患者（63.6%）进行了支架置入。除治疗期间1例穿刺部位出血外，无脑再出血事件或其他严重并发症。在12个月随访时，共有90.9%（11例中的10例）患者存活，7例患者获得良好功能结局。在1年随访时，有1例患者（10%）发生轻度PTS。超声显示髂股静脉通畅率为100%，1例患者观察到股静脉瓣膜功能不全。
经皮机械血栓切除术对于近期发生aSAH的特定急性髂股DVT患者似乎是一种可行且安全的治疗方法，在恢复通畅和降低PTS风险方面显示出有前景的结果。
