Huang Qun, Zhang Xing, Zhang Linjie, Qin Jinbao, Yang Xinrui, Ye Kaichuang, Lu Xinwu, Wang Ruihua, Peng Zhiyou
Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Vascular Center of Shanghai Jiao Tong University, Shanghai, China.
Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Vascular Center of Shanghai Jiao Tong University, Shanghai, China.
J Vasc Interv Radiol. 2025 Apr;36(4):574-580. doi: 10.1016/j.jvir.2024.12.584. Epub 2024 Dec 26.
To evaluate whether endovascular therapy (ET) improved early symptom relief and decreased the incidence of moderate-to-severe postthrombotic syndrome (PTS) compared with anticoagulation alone in patients with subacute (15-28 days) iliofemoral deep vein thrombosis (DVT).
Consecutive patients with subacute iliofemoral DVT from January 2020 to June 2022 were identified. A total of 86 patients were assigned to receive treatment with ET alongside anticoagulation (endovascular group, n = 49) or anticoagulation alone (anticoagulation group, n = 37). Effectiveness outcomes including thrombus clearance rate, symptoms relief in 3 days (pain and swelling score), moderate-to-severe PTS rate, Villalta score, and Venous Clinical Severity Score (VCSS) at 12 months as well as safety outcomes including major bleeding, minor bleeding, and death within 12 months were compared between the 2 groups.
The endovascular group demonstrated greater symptoms relief in 3 days (1.1 ± 1.0 vs 3.6 ± 1.1; P < .001). The mean follow-up duration was 15.9 months for the endovascular group and 14.7 months for the anticoagulation group. Seventy-nine patients (91.8%) completed the 12-month follow-up. Villalta score (3.9 ± 2.6 vs 5.7 ± 4.3; P = .027), moderate-to-severe PTS (6.5% vs 27.3%; P = .011), and VCSS (2.3 ± 1.6 vs 3.6 ± 2.6; P = .004) at 12 months were significantly lower in the endovascular group. No significant differences were observed regarding minor bleeding events, recurrence of symptomatic DVT, and deaths between the 2 groups.
In patients with subacute iliofemoral DVT, the addition of ET to anticoagulation provided greater early symptoms relief and reduced the occurrence of moderate-to-severe PTS, with similar safety outcomes.
评估与单纯抗凝治疗相比，血管内治疗（ET）是否能改善亚急性（15 - 28天）髂股深静脉血栓形成（DVT）患者的早期症状缓解情况，并降低中重度血栓后综合征（PTS）的发生率。
纳入2020年1月至2022年6月期间连续的亚急性髂股DVT患者。总共86例患者被分配接受ET联合抗凝治疗（血管内治疗组，n = 49）或单纯抗凝治疗（抗凝组，n = 37）。比较两组的有效性指标，包括血栓清除率、3天内症状缓解情况（疼痛和肿胀评分）、12个月时的中重度PTS发生率、Villalta评分和静脉临床严重程度评分（VCSS），以及安全性指标，包括12个月内的大出血、小出血和死亡情况。
血管内治疗组在3天内症状缓解更明显（1.1±1.0 vs 3.6±1.1；P <.001）。血管内治疗组的平均随访时间为15.9个月，抗凝组为14.7个月。79例患者（91.8%）完成了12个月的随访。血管内治疗组在12个月时的Villalta评分（3.9±2.6 vs 5.7±4.3；P =.027）、中重度PTS发生率（6.5% vs 27.3%；P =.011）和VCSS（2.3±1.6 vs 3.6±2.6；P =.004）均显著更低。两组在小出血事件、症状性DVT复发和死亡方面未观察到显著差异。
在亚急性髂股DVT患者中，抗凝治疗联合ET能提供更显著的早期症状缓解，并减少中重度PTS的发生，且安全性相当。
