Thrombosis Expertise Center, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
Thrombosis Expertise Center, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
J Thromb Haemost. 2024 Dec;22(12):3552-3561. doi: 10.1016/j.jtha.2024.08.022. Epub 2024 Sep 17.
Adjunctive catheter-directed thrombolysis shows variable efficacy in preventing postthrombotic syndrome (PTS), despite restored patency.
This Ultrasound-Accelerated Catheter-Directed Thrombolysis Versus Anticoagulation for the Prevention of Post-Thrombotic Syndrome (CAVA) trial subanalysis investigated the effect of ultrasound-accelerated catheter-directed thrombolysis (UACDT) on patency, reflux, and their relevance in PTS development.
This multicenter, randomized, single-blind trial enrolled patients (aged 18-85 years) with a first iliofemoral deep vein thrombosis and symptom duration ≤14 days. Patency and reflux were assessed by duplex ultrasound at 12 months (T12) and long-term (LT) follow-up (median, 39.5 months; IQR, 24.0-63.0 months). PTS was diagnosed using the Villalta score.
UACDT significantly improved patency in all vein segments at T12 (60.3% UACDT vs 25.9% standard treatment [ST]; P = .002) and LT (45.2% UACDT vs 11.9% ST; P < .001). Popliteal patency, however, was similar between groups (87.9% UACDT vs 83.3% ST; P = .487). Reflux was similar between groups at T12 and LT; only popliteal reflux was significantly reduced in the UACDT group at LT (22.6% UACDT vs 44.8% ST; P = .010). Absent iliac patency at T12 was associated with increased PTS risk in the ST group only (odds ratio [OR], 10.84; 95% CI, 1.93-60.78; P = .007). In the UACDT group, popliteal reflux at T12 was associated with moderate-to-severe PTS at T12 (OR, 4.88; 95% CI, 1.10-21.57; P = .041) and LT (OR, 5.83; 95% CI, 1.44-23.63; P = .009). Combined popliteal reflux and absent iliac patency significantly amplified PTS risk (OR, 10.79; 95% CI, 2.41-48.42; P < .001).
UACDT improved patency and reduced popliteal reflux. Iliac patency and popliteal reflux are independently associated with moderate-to-severe PTS and contribute synergistically to its development. However, a proportion of moderate-to-severe PTS cases lacks an evident underlying cause.
尽管恢复了通畅性，但辅助性导管溶栓治疗在预防血栓后综合征（PTS）方面的疗效存在差异。
本 Ultrasound-Accelerated Catheter-Directed Thrombolysis Versus Anticoagulation for the Prevention of Post-Thrombotic Syndrome（CAVA）试验亚分析旨在探讨超声加速导管溶栓（UACDT）对通畅性、反流及其与 PTS 发展相关性的影响。
这项多中心、随机、单盲试验纳入了首次髂股深静脉血栓形成且症状持续时间≤14 天的 18-85 岁患者。在 12 个月（T12）和长期（LT）随访（中位数 39.5 个月；IQR 24.0-63.0 个月）时，通过双功能超声评估通畅性和反流。采用 Villalta 评分诊断 PTS。
UACDT 在 T12（60.3%UACDT 对比 25.9%标准治疗[ST]；P=0.002）和 LT（45.2%UACDT 对比 11.9%ST；P<0.001）时显著改善所有静脉节段的通畅性。然而，两组间腘静脉通畅性相似（87.9%UACDT 对比 83.3%ST；P=0.487）。T12 和 LT 时两组间反流相似；仅在 UACDT 组 LT 时，腘静脉反流显著减少（22.6%UACDT 对比 44.8%ST；P=0.010）。T12 时髂静脉无通畅性与 ST 组 PTS 风险增加相关（比值比[OR]，10.84；95%CI，1.93-60.78；P=0.007）。在 UACDT 组，T12 时的腘静脉反流与 T12 时的中重度 PTS（OR，4.88；95%CI，1.10-21.57；P=0.041）和 LT（OR，5.83；95%CI，1.44-23.63；P=0.009）相关。合并的腘静脉反流和髂静脉无通畅性显著放大了 PTS 风险（OR，10.79；95%CI，2.41-48.42；P<0.001）。
UACDT 改善了通畅性并减少了腘静脉反流。髂静脉通畅性和腘静脉反流与中重度 PTS 独立相关，并对其发生具有协同作用。然而，一部分中重度 PTS 病例缺乏明确的潜在原因。
