University Grenoble Alpes, Department of Imaging and Interventional Radiology, CHU Grenoble Alpes, Grenoble, France.
Cardio-Vascular and Interventional Department, Antony Private Hospital, Antony, France.
Cardiovasc Intervent Radiol. 2023 Dec;46(12):1684-1693. doi: 10.1007/s00270-023-03529-4. Epub 2023 Aug 18.
To report the effectiveness of pharmacomechanical catheter-directed thrombolysis (PCDT) in the management of acute iliofemoral deep venous thrombosis (DVT) via the jugular vein using a slow rotation and large-tip device (SRD) in a large cohort of patients.
From 2011 to 2021, 277 patients (mean age 45 years, 59.2% women) were treated in 6 centres with PCDT for ilio-fémoral DVT. PCDT was performed via the jugular vein and consisted of one session of fragmentation-fibrinolysis, aspiration and, if needed, angioplasty with stenting. The aim of PCDT was to achieve complete clearance of the venous thrombosis and to restore iliofemoral patency. Residual thrombotic load was assessed by angiography, venous patency by duplex ultrasound and clinical effectiveness by the rate of post-thrombotic syndrome (Villalta score > 4).
All patients were treated via the jugular vein using an SRD, and all but one were treated with fibrinolysis. Angioplasty with stenting was performed in 84.1% of patients. After the procedure, the residual thrombotic load at the ilio-fémoral region was < 10% in 96.1% of patients. The rate of major complications was 1.8% (n = 5), the rate of minor complications was 4% (n = 11), and one patient died from pulmonary embolism (0.4%) At a median follow-up of 24 months, primary and secondary iliofemoral patency was 89.6% and 95.8%, respectively. The rate of PTS was 13.8% at 12 months.
PCDT via the jugular vein using an SRD is an efficient treatment for acute iliofemoral DVT and results in high long-term venous patency and low PTS rates. Level of evidence Level 4, Case series.
报告通过颈静脉使用缓慢旋转大尖端装置（SRD）对 277 例（平均年龄 45 岁，59.2%为女性）急性髂股深静脉血栓形成（DVT）患者进行药物机械性导管溶栓（PCDT）的效果。
2011 年至 2021 年，6 家中心对 277 例髂股 DVT 患者进行了 PCDT 治疗。PCDT 通过颈静脉进行，包括一次碎片溶栓、抽吸，如果需要，还进行血管成形术和支架置入。PCDT 的目的是完全清除静脉血栓并恢复髂股通畅。通过血管造影评估残余血栓负荷，通过双功能超声评估静脉通畅性，通过血栓后综合征（Villalta 评分>4）发生率评估临床疗效。
所有患者均通过颈静脉使用 SRD 进行治疗，除 1 例外均接受溶栓治疗。84.1%的患者进行了血管成形术和支架置入。治疗后，96.1%的患者髂股区域残余血栓负荷<10%。主要并发症发生率为 1.8%（n=5），小并发症发生率为 4%（n=11），1 例患者死于肺栓塞（0.4%）。中位随访 24 个月时，原发和继发髂股通畅率分别为 89.6%和 95.8%。12 个月时血栓后综合征发生率为 13.8%。
通过颈静脉使用 SRD 的 PCDT 是治疗急性髂股 DVT 的有效方法，可获得较高的长期静脉通畅率和较低的 PTS 发生率。证据等级 4，病例系列。
