Medical Faculty, University of Zurich, Switzerland.
Department of Angiology, University Hospital Zurich, Switzerland.
Vasa. 2023 Nov;52(6):416-422. doi: 10.1024/0301-1526/a001097. Epub 2023 Oct 17.
Pharmaco-mechanical thrombectomy (PMT) and catheter-directed thrombolysis (CDT) are therapeutic options for selected patients with acute deep vein thrombosis (DVT) to prevent post-thrombotic syndrome (PTS). We aimed to describe the clinical characteristics and outcomes of 159 patients with symptomatic iliofemoral DVT undergoing PMT alone, CDT alone, or CDT followed by PMT (bail-out) in the Swiss Venous Stent Registry. The primary outcome was the incidence of peri-interventional major and minor bleeding complications (ISTH criteria). Secondary outcomes included the incidence of PTS and stent patency after 3 years. Mean age was 49±20 years and 58% were women. DVT involved the iliac veins in 99% of patients, whereas 53% had an underlying iliac vein compression. PMT alone was used in 40 patients, CDT alone in 77, and 42 received initial CDT followed by bail-out PMT due to insufficient thrombus clearance. Single-session PMT was the preferred approach in patients with iliac vein compression, patent popliteal vein, and absence of IVC thrombus. Patients treated with PMT alone received a lower r-tPA dose (median 10 mg, IQR 10-10) vs. those treated with CDT (20 mg, IQR 10-30). The rate of peri-interventional major bleeding was 0%, 1%, and 2%, whereas that of minor bleeding was 0%, 1%, and 12%, respectively, all occurring during CDT. After 3 years, PTS occurred in 6%, 9%, and 7% of patients, respectively. The primary stent patency rate was 95%, 88%, and 83%, respectively. The use of PMT and CDT for iliofemoral DVT was overall safe and resulted in high long-term patency and treatment success. Given the less severe presentation of DVT, single-session PMT appeared to be characterized by numerically better primary patency and lower perioperative bleeding event rates than CDT.
药物机械血栓切除术 (PMT) 和导管定向溶栓术 (CDT) 是治疗选择的一部分，用于预防血栓后综合征 (PTS)，以治疗有症状的急性深静脉血栓形成 (DVT) 的患者。我们旨在描述在瑞士静脉支架注册中心，159 例接受单独 PMT、单独 CDT 或 CDT 后行 PMT（ bailout）的有症状髂股 DVT 患者的临床特征和结局。主要结局是围介入期主要和次要出血并发症的发生率（ISTH 标准）。次要结局包括 3 年后 PTS 和支架通畅率的发生率。 平均年龄为 49±20 岁，58%为女性。DVT 累及髂静脉 99%的患者，而 53%的患者存在髂静脉受压。40 例患者接受单独 PMT，77 例患者接受单独 CDT，42 例患者因血栓清除不充分而接受初始 CDT 后 bailout PMT。对于存在髂静脉受压、隐股静脉通畅和 IVC 血栓的患者，单次 PMT 是首选方法。单独接受 PMT 的患者接受的 r-tPA 剂量较低（中位数 10mg，IQR10-10），而接受 CDT 的患者剂量较高（20mg，IQR10-30）。围介入期大出血的发生率分别为 0%、1%和 2%，小出血的发生率分别为 0%、1%和 12%，均发生在 CDT 期间。3 年后，分别有 6%、9%和 7%的患者发生 PTS。主要支架通畅率分别为 95%、88%和 83%。 髂股 DVT 采用 PMT 和 CDT 治疗总体上是安全的，长期通畅率和治疗成功率较高。鉴于 DVT 的表现相对较轻，单次 PMT 似乎具有更高的原发性通畅率和更低的围手术期出血事件发生率，与 CDT 相比具有优势。
