Ni Qihong, Zhao Yiping, Xue Guanhua, Guo Xiangjiang, Wang Weilun, Ye Meng, Chen Jiaquan, Zhang Lan
Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
J Endovasc Ther. 2024 Jul 26:15266028241266223. doi: 10.1177/15266028241266223.
The study aimed to investigate the early results of directional femoral ultrasound-guided compression technique (UCT) using in percutaneous mechanical thrombectomy (PMT) for acute deep vein thrombosis (DVT).
Consecutive single-center patients with acute iliofemoral DVT who underwent PMT from January 2020 to December 2021 were included. Directional femoral UCT was used to adjust the PMT catheter into the residual thrombus in the inguinal region by ultrasound compression to improve the thrombus clearance rate. Patients were retrospectively analyzed and divided into 2 groups based on PMT with or without directional femoral UCT. The primary efficacy outcome was the incidence of post-thrombotic syndrome (PTS) at 24-month follow-up. The secondary efficacy outcomes included common femoral venous thrombus removal grade, total thrombus removal grade, venous primary patency rate, and incidence of moderate-to-severe PTS at 24-month follow-up. The safety outcomes included complications, major bleeding events, and death at 24-month follow-up.
A total of 96 patients were included in the study: 42 patients underwent PMT with directional femoral UCT and 54 patients underwent PMT without UCT. There was no significant difference in baseline characteristics between the 2 groups. The percentages of patients achieved common femoral venous thrombus removal grade 3 and total thrombus removal grade 3 were significantly higher in the PMT with UCT group than those in the PMT without UCT group (p<0.001). The 24-month primary patency rate was significantly higher in the PMT with UCT group than that in the PMT without UCT group (90.0% vs 71.2%, p=0.027). The incidence of PTS was significantly lower in the PMT with UCT group (10.0%) than that in the PMT without UCT group (28.8%) (p=0.027).
PMT with directional femoral UCT could improve the thrombus clearance rate and primary patency rate of acute iliofemoral DVT and might decrease the incidence of PTS compared to traditional PMT treatment without UCT.
Residual thrombus in common femoral vein is a difficult problem associated with higher incidence of PTS. Few studies have focused on common femoral venous thrombus clearance. PMT with directional femoral UCT could improve the thrombus clearance rate and primary patency rate of acute iliofemoral DVT, and might decrease the incidence of PTS compared to traditional PMT treatment without UCT. Directional femoral UCT is recommended in PMT treatment of acute iliofemoral DVT.
本研究旨在探讨在急性深静脉血栓形成（DVT）的经皮机械血栓切除术（PMT）中使用股动脉超声引导压迫技术（UCT）的早期结果。
纳入2020年1月至2021年12月期间在单中心接受PMT治疗的连续性急性髂股DVT患者。采用股动脉UCT通过超声压迫将PMT导管调整至腹股沟区的残余血栓处，以提高血栓清除率。对患者进行回顾性分析，并根据是否使用股动脉UCT进行PMT分为两组。主要疗效指标为24个月随访时血栓后综合征（PTS）的发生率。次要疗效指标包括股总静脉血栓清除分级、总血栓清除分级、静脉原发性通畅率以及24个月随访时中重度PTS的发生率。安全性指标包括24个月随访时的并发症、大出血事件和死亡情况。
本研究共纳入96例患者：42例患者接受了股动脉UCT辅助的PMT，54例患者接受了未使用UCT的PMT。两组患者的基线特征无显著差异。股动脉UCT辅助的PMT组达到股总静脉血栓清除3级和总血栓清除3级的患者百分比显著高于未使用UCT的PMT组（p<0.001）。股动脉UCT辅助的PMT组24个月的原发性通畅率显著高于未使用UCT的PMT组（90.0%对71.2%，p=0.027）。股动脉UCT辅助的PMT组PTS的发生率显著低于未使用UCT的PMT组（10.0%对28.8%）（p=0.027）。
与未使用UCT的传统PMT治疗相比，股动脉UCT辅助的PMT可提高急性髂股DVT的血栓清除率和原发性通畅率，并可能降低PTS的发生率。
股总静脉残余血栓是一个与PTS发生率较高相关的难题。很少有研究关注股总静脉血栓清除。与未使用UCT的传统PMT治疗相比，股动脉UCT辅助的PMT可提高急性髂股DVT的血栓清除率和原发性通畅率，并可能降低PTS的发生率。在急性髂股DVT的PMT治疗中推荐使用股动脉UCT。
