Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, PR China.
Br J Radiol. 2023 Aug;96(1148):20230094. doi: 10.1259/bjr.20230094. Epub 2023 May 25.
To investigate the safety and effectiveness of catheter-based therapy (CBT) using AngioJet rheolytic thrombectomy (ART) device or large lumen catheter (LLC) in the oncological patients with inferior vena cava thrombosis (IVCT).
This was a retrospective study including eligible patients with IVCT treated with CBT coupled with dose-reduced thrombolysis as the first-line treatment from February 1, 2015 to January 1, 2022. The baseline demographics, comorbidities, clinical characteristics, treatment details, course data were all reviewed.
A total of 33 patients (mean age 58.8 years, 57.6% male) was included, of whom 17 patients underwent ART and 16 underwent LLC aspiration, the technical success rates were 100%. All patients subsequently underwent catheter-directed thrombolysis relative to reduced-dose thrombolysis. At the end of catheter-directed thrombolysis, clinical success was achieved in 26 (78.8%) patients. In the subgroup analysis, ART seemed to receive a slightly higher rate of thrombus removal Grade III (47.1% 12.5%, = .057). The symptoms of leg pain and swelling post-treatment were significantly improved in both groups ( < .001). Except for transient macroscopic hemoglobinuria occurring in patients with ART, none of all patients suffered from procedure-related adverse events and major complications. Minor complications such as bleeding events occurred in 6.1% (2/33) of patients. At the 6 month follow-up, the incidence of recurrent thrombosis and mild post-thrombotic syndrome (PTS) were 9.7% (3/31) and 6.5% (2/31).
CBT is a safe and effective modality for the management of IVCT in the oncological patients, leading to high levels of technical and clinical success, symptoms alleviation, as well as a low incidence of minor complication, mild PTS and recurrence.
The available data and evidence of endovascular therapy (ET) on oncologic patients with IVCT remains insufficient. The purpose of present single center retrospective study including 33 oncological patients is to investigate the preliminary safety and efficacy of CBT using ART device or LLC. The results demonstrated that CBTs are safe and effective as an ET modality in majority of eligible patients with symptomatic acute cancer-associated IVCT, indicating high levels of technical and clinical success, symptoms alleviation, as well as a low prevalence of minor complication, mild post-thrombotic syndrome and recurrence. Furthermore, they have the advantages of accelerated reduction of thrombus burden in a moderate time, speedy restoration of blood flow, but at the risk of potentially increased economic cost. Notably, in the condition of parallel time and dosages of lytic agents, ART tends to achieve a slightly higher thrombus removal Grade III than LLCA.
研究使用 AngioJet 旋切血栓清除术（ART）装置或大腔导管（LLC）进行经导管治疗（CBT）在伴有下腔静脉血栓形成（IVCT）的肿瘤患者中的安全性和有效性。
这是一项回顾性研究，纳入了 2015 年 2 月 1 日至 2022 年 1 月 1 日期间接受 CBT 联合减剂量溶栓治疗作为一线治疗的 IVCT 肿瘤患者。回顾了患者的基线人口统计学、合并症、临床特征、治疗细节和病程数据。
共纳入 33 例患者（平均年龄 58.8 岁，57.6%为男性），其中 17 例接受了 ART 治疗，16 例接受了 LLC 抽吸治疗，技术成功率为 100%。所有患者随后均接受了导管直接溶栓治疗。在导管直接溶栓结束时，26 例（78.8%）患者达到临床成功。在亚组分析中，ART 似乎能达到稍高的血栓清除分级 III（47.1%比 12.5%，=0.057）。两组患者的腿部疼痛和肿胀症状在治疗后均显著改善（均<.001）。除 ART 治疗的患者出现一过性肉眼血尿外，所有患者均未发生与治疗相关的不良事件和主要并发症。少数并发症如出血事件在 6.1%（2/33）的患者中发生。在 6 个月的随访中，复发性血栓形成和轻度血栓后综合征（PTS）的发生率分别为 9.7%（3/31）和 6.5%（2/31）。
CBT 是治疗肿瘤患者 IVCT 的一种安全有效的方法，可实现较高的技术和临床成功率，缓解症状，且并发症发生率低，轻度 PTS 和复发率低。
关于肿瘤患者伴发 IVCT 的血管内治疗（ET）的现有数据和证据仍然不足。本单中心回顾性研究纳入了 33 例肿瘤患者，旨在初步探讨使用 ART 装置或 LLC 的 CBT 的安全性和疗效。结果表明，在大多数有症状的急性伴发癌症的 IVCT 肿瘤患者中，CBT 作为一种 ET 方法是安全有效的，可实现较高的技术和临床成功率，缓解症状，且并发症发生率低，轻度 PTS 和复发率低。此外，CBT 可在相对较短的时间内加速血栓负荷的减少，迅速恢复血流，但存在潜在增加经济成本的风险。值得注意的是，在溶栓药物的平行时间和剂量条件下，ART 达到的血栓清除分级 III 似乎稍高于 LLC。
