Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030-4009, USA.
Section of Benign Hematology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Cardiovasc Intervent Radiol. 2024 May;47(5):556-566. doi: 10.1007/s00270-024-03691-3. Epub 2024 Mar 28.
Venous thromboembolism (VTE) is a major contributor to the mortality of cancer patients. Mechanical thrombectomy (MT) is an endovascular technique that physically removes a thrombus without thrombolytics. The purpose of this study was to evaluate safety, efficacy, and clinical outcomes following MT for lower extremity DVT in cancer patients.
This single-center, retrospective study evaluated outcomes following MT of lower extremity DVT in cancer patients from November 2019 to May 2023. The primary outcome measure was clinical success, defined as a decrease in Villalta score by at least 2 points following the intervention. Secondary outcomes included repeat intervention-free survival and overall survival. Technical success was defined as restoring venous flow with mild (< 10%) or no residual filling defect.
In total, 90 patients and 113 procedures were included. Technical and clinical success was achieved in 81% and 87% of procedures performed. Repeat intervention-free survival at 1 month, 3 months, and 6 months post-procedure was 92%, 82%, and 77%, respectively. The complication rate was 2.7%. Pathologic analysis of the extracted thrombus revealed tumor thrombus in 18.4% (18/98) samples. Overall survival for the study cohort was 87% at 1 month, 74% at 3 months, and 62% at 6 months. Patients who were found to have tumor thrombi were noted to have a decreased overall survival compared to patients with non-tumor thrombi (P = 0.012).
MT is safe and efficacious in reducing cancer patients' VTE-related symptoms. The high rate of tumor thrombus in thrombectomy specimens suggests this phenomenon is more common than suspected.
静脉血栓栓塞症（VTE）是癌症患者死亡的主要原因之一。机械血栓切除术（MT）是一种血管内技术，无需溶栓即可物理去除血栓。本研究的目的是评估 MT 治疗癌症患者下肢深静脉血栓形成（DVT）的安全性、疗效和临床结果。
这项单中心回顾性研究评估了 2019 年 11 月至 2023 年 5 月期间，MT 治疗癌症患者下肢 DVT 的结果。主要结局指标是临床成功率，定义为干预后 Villalta 评分至少降低 2 分。次要结局包括重复干预无复发生存率和总生存率。技术成功率定义为恢复静脉血流，轻度（<10%）或无残留充盈缺损。
共纳入 90 例患者和 113 例手术。81%和 87%的手术达到了技术和临床成功。术后 1 个月、3 个月和 6 个月的重复干预无复发生存率分别为 92%、82%和 77%。并发症发生率为 2.7%。对提取的血栓进行病理分析显示，18.4%（18/98）的样本中存在肿瘤血栓。研究队列的总体生存率为术后 1 个月 87%，3 个月 74%，6 个月 62%。与非肿瘤血栓患者相比，发现有肿瘤血栓的患者总生存率降低（P=0.012）。
MT 可安全有效地减轻癌症患者的 VTE 相关症状。血栓切除术标本中肿瘤血栓的高发生率表明，这种现象比预期的更为常见。
