Donohue Jack K, Li Kevin, Tang Anthony, Kann Rachel J, Vodovotz Lena, Abou Ali Adham N, Chaer Rabih A, Sridharan Natalie D
Division of Vascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Division of Vascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Ann Vasc Surg. 2025 Feb;111:55-62. doi: 10.1016/j.avsg.2024.11.007. Epub 2024 Nov 22.
Iliofemoral deep venous thrombosis is strongly associated with post-thrombotic syndrome (PTS). Interventional treatment options include catheter-directed thrombolysis and pharmacomechanical thrombectomy. More recently, there has been a wide dissemination of large-bore devices for mechanical thrombectomy (MT). Both treatment types have been shown to be effective in clinical practice; however, the rates of PTS after MT are poorly characterized.
We conducted a retrospective review of patients with acute iliofemoral deep venous thrombosis from 2007 to 2022. Patients were divided into 2 treatment groups: pharmacomechanical catheter-directed thrombolysis (PCDT) and MT with large-bore devices. Our primary endpoint was PTS (Villalta score >4). Secondary outcomes included vessel patency, mortality, and moderate/severe PTS (Villalta score >9). Predictors of PTS were analyzed using multivariable logistic regression.
The median age of our cohort (n = 349) was 49 (interquartile range 35-63) years, 54.2% were female. There were 294 (84.2%) patients treated with PCDT. There were no significant baseline characteristic differences between patients treated with PCDT versus MT aside from increased preoperative anticoagulant use in the MT cohort. The overall rate of PTS was 19.1%. There were no differences in rates of PTS, moderate-severe PTS, stent patency, mortality between groups, or hospital length of stay. However, patients treated with MT had higher rates of single operating room visit during their admission treatment relative to patients that underwent PCDT (33.3% vs. 9.0%, P < 0.01) and decreased intensive care unit length of stay (2 (1-3) vs. 0.5 (0-2), P < 0.01). MT treatment was not a risk factor for the development of PTS (adjusted odds ratio [aOR] 0.73; [95% confidence interval {CI} 0.30, 1.74]; P = 0.47) or associated with increased Villalta score (β: -0.34; [95% CI-1.28, 0.60]; P = 0.47). Infrainguinal deep venous thrombosis extension (aOR 2.18; [95% CI 1.16, 4.09]; P = 0.02), prior deep venous thrombosis (aOR 2.67; [95% CI 1.38, 5.13]; P < 0.01), and a hypercoagulable state (aOR 2.32; [95% CI 1.19, 4.50]; P = 0.01) were associated with increased risk of PTS.
Treatment with large-bore MT was not a significant predictor for the development of PTS. MT appears safe, durable, and associated with greater rates of single operating room visit relative to PCDT, which suggests that rapid thrombus removal may be of value.
髂股深静脉血栓形成与血栓后综合征（PTS）密切相关。介入治疗选择包括导管直接溶栓和药物机械性血栓清除术。最近，大口径机械血栓清除术（MT）设备已广泛应用。两种治疗方法在临床实践中均已证明有效；然而，MT术后PTS的发生率尚无明确特征。
我们对2007年至2022年急性髂股深静脉血栓形成患者进行了回顾性研究。患者分为2个治疗组：药物机械性导管直接溶栓（PCDT）组和大口径设备MT组。我们的主要终点是PTS（Villalta评分>4）。次要结局包括血管通畅、死亡率和中度/重度PTS（Villalta评分>9）。使用多变量逻辑回归分析PTS的预测因素。
我们队列中的患者（n = 349）中位年龄为49岁（四分位间距35 - 63岁），54.2%为女性。有294例（84.2%）患者接受了PCDT治疗。除MT队列术前抗凝药物使用增加外，PCDT与MT治疗患者的基线特征无显著差异。PTS总发生率为19.1%。两组之间在PTS、中度 - 重度PTS、支架通畅率、死亡率或住院时间方面无差异。然而，与接受PCDT的患者相比，接受MT治疗的患者在入院治疗期间单次手术室就诊率更高（33.3%对9.0%，P < 0.01），重症监护病房住院时间缩短（2（1 - 3）对0.5（0 - 2），P < 0.01）。MT治疗不是PTS发生的危险因素（调整优势比[aOR] 0.73；[95%置信区间{CI} 0.30，1.74]；P = 0.47），也与Villalta评分增加无关（β： - 0.34；[95% CI - 1.28，0.60]；P = 0.47）。股腘以下深静脉血栓扩展（aOR 2.18；[95% CI 1.16，4.09]；P = 0.02）、既往深静脉血栓形成（aOR 2.67；[95% CI 1.38，5.13]；P < 0.01）和高凝状态（aOR 2.32；[95% CI 1.19，4.50]；P = 0.01）与PTS风险增加相关。
大口径MT治疗不是PTS发生的重要预测因素。MT似乎安全、持久，与PCDT相比单次手术室就诊率更高，这表明快速清除血栓可能有价值。
