Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
J Vasc Surg Venous Lymphat Disord. 2023 Jul;11(4):843-853.e2. doi: 10.1016/j.jvsv.2023.01.010. Epub 2023 Mar 7.
Patients with severe acute low iliofemoral deep vein thrombosis (DVT), such as phlegmasia cerulea dolens, benefit from catheter-directed thrombolysis (CDT). This meta-analysis investigated the effectiveness and safety of adjuvant percutaneous mechanical thrombectomy (PMT) during CDT compared with CDT alone in the treatment of acute iliofemoral DVT.
A meta-analysis was performed in accordance with the PRISMA guidelines. Medline, Embase, the Cochrane Library, China National Knowledge Internet, and Wanfang data were searched for studies on the management of acute iliofemoral DVT by means of CDT or CDT with adjuvant PMT. Randomized, controlled trials and nonrandomized studies were included. The primary outcomes were venous patency rate, major bleeding complications, and post-thrombotic syndrome occurrence within 2 years of the procedure. The secondary outcomes were thrombolytic time and volume, as well as the rates of thigh detumescence and iliac vein stenting.
The meta-analysis included 20 eligible studies with a total of 1686 patients. The rates of venous patency (mean difference, 10.11; 95% confidence interval [CI], 5.59-14.62) and thigh detumescence (mean difference, 3.64; 95% CI, 1.10-6.18) of the adjuvant PMT group were higher than those of the CDT alone group. Compared with CDT alone, the adjuvant PMT group experienced fewer incidences of major bleeding complications (odds ratio, 0.45; 95% CI, 0.26-0.77) and occurrences of post-thrombotic syndrome within 2 years of the procedure (odds ratio, 0.55; 95% CI, 0.33-0.92). Furthermore, the duration of thrombolytic therapy was shorter, and the total dose of administered thrombolytics was lower with adjuvant PMT.
Adjuvant PMT during CDT is associated with improved clinical outcomes and a lower incidence of major bleeding complications. The studies investigated were, however, single-center cohort studies, and future randomized controlled trials are needed to substantiate these findings.
对于患有严重急性下肢髂股深静脉血栓形成（DVT）的患者，如蓝趾综合征，导管直接溶栓（CDT）治疗有效。本 meta 分析旨在探讨 CDT 联合辅助经皮机械血栓切除术（PMT）与单独 CDT 治疗急性髂股 DVT 的有效性和安全性。
根据 PRISMA 指南进行 meta 分析。检索 Medline、Embase、Cochrane 图书馆、中国知网和万方数据中关于 CDT 或 CDT 联合辅助 PMT 治疗急性髂股 DVT 的管理的研究。纳入随机对照试验和非随机研究。主要结局为静脉通畅率、主要出血并发症和术后 2 年内血栓后综合征的发生率。次要结局为溶栓时间和溶栓量，以及大腿消肿率和髂静脉支架置入率。
该 meta 分析纳入了 20 项符合条件的研究，共 1686 例患者。辅助 PMT 组的静脉通畅率（均数差，10.11；95%置信区间 [CI]，5.59-14.62）和大腿消肿率（均数差，3.64；95% CI，1.10-6.18）均高于 CDT 组。与单独 CDT 相比，辅助 PMT 组主要出血并发症的发生率（比值比，0.45；95% CI，0.26-0.77）和术后 2 年内血栓后综合征的发生率（比值比，0.55；95% CI，0.33-0.92）均较低。此外，辅助 PMT 组的溶栓治疗时间更短，溶栓药物总剂量更低。
CDT 联合辅助 PMT 可改善临床结局，降低主要出血并发症的发生率。但纳入的研究均为单中心队列研究，需要进一步的随机对照试验来证实这些发现。
