Department of Internal Medicine, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland.
Department of Angiology, University Hospital Zurich, Switzerland.
Vasa. 2022 Sep;51(5):282-290. doi: 10.1024/0301-1526/a001017. Epub 2022 Jul 1.
Catheter-based thrombus removal (CBTR) reduces the risk of moderate to severe post-thrombotic syndrome (PTS) in patients with acute iliofemoral deep vein thrombosis (IF-DVT). However, the impact of concomitant popliteal DVT on clinical and duplex sonographic outcomes is unknown. In this post-hoc analysis including the entire cohort of the randomized controlled BERNUTIFUL trial (48 patients), we compared clinical (incidence/severity of PTS assessed by Villalta score and revised venous clinical severity scores, rVCSS), disease-specific quality-of-life (QOL, CIVIQ-20 survey) and duplex sonographic outcomes (patency, reflux, post-thrombotic lesions) at 12 months follow-up between patients with IF-DVT and concomitant popliteal DVT treated by CBTR. Overall, 48 IF-DVT patients were included (48% men, median age of 50 years), of whom 17 (35%) presented popliteal DVT. At baseline, patients popliteal DVT were older, had a higher body mass index and more important leg swelling. At 12 months, freedom from PTS (93% vs 87%, P=0.17), median total Villalta score (1 vs 1.5; P=0.46), rVCSS (2 vs 1.5, P=0.5) and disease-specific QOL (24 points vs 24 points, P=0.72) were similar between patient and popliteal DVT, respectively. Duplex sonographic outcomes were similar, except for more frequent popliteal post-thrombotic lesions and reflux (P=0.02) in patients popliteal DVT. Relevant clinical outcomes 1 year after successful CBTR were favorable, regardless of the presence or absence of concomitant popliteal DVT. However, post-thrombotic popliteal vein lesions and reflux are more frequent in IF-DVT patients with popliteal involvement. Their impact on long-term outcomes remains to be investigated.
基于导管的血栓清除术（CBTR）可降低急性髂股深静脉血栓形成（IF-DVT）患者发生中重度血栓后综合征（PTS）的风险。然而，同时合并腘静脉血栓形成（DVT）对临床和双功能超声检查结果的影响尚不清楚。在这项包括随机对照 BERNUTIFUL 试验（共 48 例患者）全部队列的事后分析中，我们比较了 IF-DVT 合并同时合并腘静脉 DVT 患者接受 CBTR 治疗 12 个月后的临床（采用 Villalta 评分和改良静脉临床严重程度评分（rVCSS）评估 PTS 的发生率/严重程度）、疾病特异性生活质量（CIVIQ-20 调查）和双功能超声检查结果（通畅性、反流、血栓后病变）。共有 48 例 IF-DVT 患者（48%为男性，中位年龄为 50 岁）入选，其中 17 例（35%）存在腘静脉 DVT。基线时，合并腘静脉 DVT 的患者年龄更大，BMI 更高，腿部肿胀更为明显。12 个月时，两组患者 PTS 发生率（93% vs 87%，P=0.17）、中位总 Villalta 评分（1 分 vs 1.5 分，P=0.46）、rVCSS（2 分 vs 1.5 分，P=0.5）和疾病特异性生活质量（24 分 vs 24 分，P=0.72）相似。除了在合并腘静脉 DVT 的患者中更常见的腘静脉血栓后病变和反流（P=0.02）外，两组患者的双功能超声检查结果相似。在成功接受 CBTR 治疗 1 年后，无论是否同时合并腘静脉 DVT，均有较好的相关临床结局。然而，IF-DVT 患者合并腘静脉受累时，血栓后腘静脉病变和反流更为常见。其对长期结局的影响仍有待研究。
