Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Division of Vascular Surgery, New York University Langone Health, New York, NY.
J Vasc Surg Venous Lymphat Disord. 2023 Jul;11(4):816-823. doi: 10.1016/j.jvsv.2023.03.019. Epub 2023 Apr 14.
Limited therapeutic strategies are available for adults with isolated renal vein thrombosis (RVT). In the present study, we explore and compare the efficacy of anticoagulation therapy alone vs anticoagulation plus endovascular intervention in the treatment of this rare disease.
In the present study, we analyzed the clinical data of RVT patients treated in a tertiary referral center in urban China from April 2012 to April 2022. These patients were classified into anticoagulation therapy (best medical treatment [BMT]) and endovascular intervention (endovascular-based treatment [EBT]) groups. The primary end points, including thrombus clearance and renal function changes, were evaluated by measuring the serum creatinine levels and glomerular filtration rates (GFRs).
A total of 40 consecutive patients with RVT (25 men and 15 women) were included in the present study, with a median age of 37 years (range, 18-72 years). Some patients developed symptoms, including 12 with low back pain (30%), 11 with lower extremity edema (28%), and 10 with abdominal pain (30%). Nephrotic syndrome was the underlying etiology for most patients (30 of 40; 75%). Additionally, 28 patients (70%) developed unilateral RVT, including 18 cases of left RVT (45%). Of the 40 patients, 17 had received BMT (42%) and 23 had received EBT (58%). In the acute phase of RVT, defined as <14 days from symptom onset, the EBT group had higher thrombus clearance and better improvement of creatinine and GFR after treatment compared with the BMT group (P < .05). In the subacute phase, defined as 14 to 30 days after symptom onset, thrombus clearance was higher in the EBT group than in the BMT group (P < .05). However, the improvement in creatinine and GFR were insignificantly different between the two groups (P > .05).
The etiologies of RVT can and should be investigated. In the present study, RVT was primarily caused by nephrotic syndrome in young patients and also was attributed to malignancy and lupus nephritis. In addition to anticoagulation therapy, endovascular intervention, including catheter-directed thrombolysis and mechanical thrombectomy, contributed to the improvement of renal function in patients with acute RVT. Endovascular intervention markedly promoted thrombus clearance in patients in the subacute phase but did not improve renal function. Therefore, endovascular intervention should be considered if RVT is diagnosed in the acute phase.
对于孤立性肾静脉血栓形成（RVT）的成人患者，治疗方法有限。本研究旨在探讨和比较抗凝治疗与抗凝联合血管内介入治疗在治疗这种罕见疾病中的疗效。
本研究分析了 2012 年 4 月至 2022 年 4 月在中国某三级转诊中心治疗的 RVT 患者的临床资料。这些患者分为抗凝治疗（最佳药物治疗[BMT]）和血管内介入治疗（血管内治疗[EBT]）组。通过测量血清肌酐水平和肾小球滤过率（GFR）评估主要终点，包括血栓清除和肾功能变化。
本研究共纳入 40 例 RVT 连续患者（25 例男性，15 例女性），中位年龄 37 岁（范围 18-72 岁）。部分患者出现症状，包括 12 例腰痛（30%）、11 例下肢水肿（28%）和 10 例腹痛（30%）。大多数患者（40 例中的 30 例；75%）的基础病因是肾病综合征。此外，28 例（70%）患者发生单侧 RVT，包括 18 例左侧 RVT（45%）。40 例患者中，17 例接受 BMT（42%），23 例接受 EBT（58%）。在 RVT 的急性期（症状出现后<14 天），EBT 组血栓清除率较高，治疗后肌酐和 GFR 改善优于 BMT 组（P<.05）。在亚急性期（症状出现后 14-30 天），EBT 组血栓清除率高于 BMT 组（P<.05）。然而，两组间肌酐和 GFR 的改善无显著差异（P>.05）。
RVT 的病因可以且应该进行调查。本研究中，RVT 主要由肾病综合征引起，主要发生在年轻患者中，也由恶性肿瘤和狼疮性肾炎引起。除抗凝治疗外，血管内介入治疗，包括导管溶栓和机械血栓切除术，有助于改善急性 RVT 患者的肾功能。血管内介入治疗显著促进亚急性期患者的血栓清除，但不能改善肾功能。因此，如果在急性期诊断出 RVT，应考虑血管内介入治疗。
