Tian Zhong, Han Hao, Tian Zhilong, Sun Pengcheng, Qin Ruihao, Yuan Fukang
Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China.
Department of Vascular Surgery of Xuzhou Central Hospital, Xuzhou, China.
Vascular. 2025 Aug;33(4):910-923. doi: 10.1177/17085381241274556. Epub 2024 Aug 12.
ObjectiveTo evaluate the safety and efficacy of pharmacomechanical thrombectomy and catheter-directed thrombolysis (CDT) as approaches to treating deep venous thrombosis of lower extremities (LEDVT).MethodsThe PubMed, Web of Science, Wanfang, Embase, Chinese Science and Technology Journal, Cochrane, and China National Knowledge Infrastructure (CNKI) databases were systematically searched for relevant articles published through October 2023, after which appropriate inclusion and exclusion criteria were used to screen out relevant articles. Review Manager 5.4.1 was used to extract key data from these studies, and pooled analyses were conducted based on mead difference (MD) or odds ratio (OR) values and corresponding 95% confidence interval (CI). Study quality was assessed with the Newcastle-Ottawa scale.Trial registrationThis study has been registered at INPLASY.COM (No. INPLASY2023100075).ResultsIn total, 31 relevant studies enrolling 2413 patients were included in this meta-analysis, with 1184 and 1229 patients in the AngioJet and CDT groups, respectively. These analyses revealed that the AngioJet group exhibited significantly higher rates of early postoperative deep vein patency (MD = 7.73, 95% CI (3.29, 12.17), = .0006) and affected limb symptom improvement (MD = 6.31, 95% CI (1.82,10.80), = .006) relative to the CDT group, whereas no differences in grade II or III thrombus clearance rates (OR = 1.30, 95% CI (0.95, 1.77), = .10) or changes in thigh circumference before and after treatment (MD = 0.01, 95% CI (-0.80, 0.83), = .97) were observed. The AngioJet group also exhibited lower urokinase doses (MD = -145.33, 95% CI (-164.28,126.38), < .00001), shorter thrombolysis time (MD = -2.35, 95% CI(-2.80, -1.90), < .00001), a less prolonged hospital stay (MD = -3.13, 95% CI(-3.81, -2.45), < .00001), lower rates of PTS incidence (OR = 0.56, 95% CI(0.36, 0.88), = .01), and reduced complication rates (OR = 0.51, 95% CI(0.31, 0.83), = .0007).ConclusionStudies published to date suggest that relative to CDT treatment, pharmacomechanical thrombectomy is associated with improved thrombus clearance, fewer complications, and lower complication rates in LEDVT patients, underscoring the safety and efficacy of this therapeutic strategy.
目的
评估药物机械性血栓切除术和导管直接溶栓术（CDT）治疗下肢深静脉血栓形成（LEDVT）的安全性和有效性。
方法
系统检索PubMed、Web of Science、万方、Embase、中国科技期刊、Cochrane和中国知网（CNKI）数据库中截至2023年10月发表的相关文章，然后使用适当的纳入和排除标准筛选出相关文章。使用Review Manager 5.4.1从这些研究中提取关键数据，并基于均值差（MD）或比值比（OR）值以及相应的95%置信区间（CI）进行汇总分析。采用纽卡斯尔-渥太华量表评估研究质量。
试验注册
本研究已在INPLASY.COM注册（编号INPLASY2023100075）。
结果
本荟萃分析共纳入31项相关研究，涉及2413例患者，其中AngioJet组和CDT组分别有1184例和1229例患者。这些分析显示，与CDT组相比，AngioJet组术后早期深静脉通畅率显著更高（MD = 7.73，95% CI（3.29，12.17），P = 0.0006），患肢症状改善更明显（MD = 6.31，95% CI（1.82，10.80），P = 0.006），而II级或III级血栓清除率（OR = 1.30，95% CI（0.95，1.77），P = 0.10）或治疗前后大腿围度变化（MD = 0.01，95% CI（-0.80，0.83），P = 0.97）无差异。AngioJet组还表现出尿激酶剂量更低（MD = -145.33，95% CI（-164.28，-126.38），P < 0.00001）、溶栓时间更短（MD = -2.35，95% CI（-2.80，-1.90），P < 0.00001）、住院时间更短（MD = -3.13，95% CI（-3.81，-2.45），P < 0.00001）、血栓后综合征（PTS）发生率更低（OR = 0.56，95% CI（0.36，0.88），P = 0.01）以及并发症发生率更低（OR = 0.51，95% CI（0.31，0.83），P = 0.0007）。
结论
迄今为止发表的研究表明，与CDT治疗相比，药物机械性血栓切除术在LEDVT患者中与更好的血栓清除效果、更少的并发症以及更低的并发症发生率相关，突出了这种治疗策略的安全性和有效性。
