Sun Lei, Yang Tao, Xu Huimin, Zhang Wenpei
Department of Vascular Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, No.99 Longcheng Street, Taiyuan, 030032, Shanxi, China.
Sci Rep. 2025 Jul 1;15(1):21050. doi: 10.1038/s41598-025-07012-7.
This retrospective analysis assesses the effectiveness and safety of pharmacomechanical thrombectomy (PMT) and join CDT (catheter-directed thrombolysis) compared to CDT and with standard anticoagulation therapy for LEDVT (acute lower extremity deep vein thrombosis) with concomitant IVCT (inferior vena cava thrombosis). From January 2014 to January 2020, a total of 114 patients were diagnosed with acute LEDVT and IVCT at Shanxi Bethune Hospital. Patients were separated into three groups: PMT ± CDT (n = 77; 25 in this group also received CDT), CDT ± catheter thrombectomy (CDT ± CT) (n = 21), and conservative management (n = 16). The following outcomes were evaluated using SPSS: thrombus clearance rates, immediate clinical remission, and limb circumference decrease in the patients. The severity of post-thrombotic syndrome (PTS) and venous patency was evaluated at 1-year and 2-year follow-ups. Our findings showed that the PMT ± CDT group had significantly greater rates of immediate clinical remission and thrombus clearance compared with CDT ± CT and conservative treatment. PMT ± CDT achieved a thrombolysis rate of 74.5%, while the CDT ± CT group had a rate of 47.2% (p < 0.001). No method of treatment significantly reduced the overall rate of post-thrombotic syndrome (PTS) (p = 0.301). However, PMT ± CDT had a significantly lower PTS severity than CDT ± CT (p = 0.023). Overall, venous patency scores were significantly better in the PMT ± CDT group at 1-year and 2-year follow-up time points. The results of this study suggest that PMT ± CDT was significantly better than CDT ± CT, as well as conservative management of patients with LEDVT and IVCT concerning both short-term and long-term outcomes. The findings further support a preference towards endovenous management as a treatment approach in clinical practice for patients with such complications.
本回顾性分析评估了与单纯导管直接溶栓（CDT）及标准抗凝治疗相比，药物机械性血栓切除术（PMT）联合CDT治疗合并下腔静脉血栓形成（IVCT）的急性下肢深静脉血栓形成（LEDVT）的有效性和安全性。2014年1月至2020年1月，山西白求恩医院共有114例患者被诊断为急性LEDVT合并IVCT。患者被分为三组：PMT±CDT组（n = 77；该组中有25例还接受了CDT）、CDT±导管血栓切除术（CDT±CT）组（n = 21）和保守治疗组（n = 16）。使用SPSS评估以下结果：患者的血栓清除率、即刻临床缓解情况和肢体周径减小情况。在1年和2年随访时评估血栓形成后综合征（PTS）的严重程度和静脉通畅情况。我们的研究结果表明，与CDT±CT组和保守治疗组相比，PMT±CDT组的即刻临床缓解率和血栓清除率显著更高。PMT±CDT组的溶栓率为74.5%，而CDT±CT组为47.2%（p < 0.001）。没有哪种治疗方法能显著降低血栓形成后综合征（PTS）的总体发生率（p = 0.301）。然而，PMT±CDT组的PTS严重程度显著低于CDT±CT组（p = 0.023）。总体而言，在1年和2年随访时间点，PMT±CDT组的静脉通畅评分显著更好。本研究结果表明，对于合并IVCT的LEDVT患者，在短期和长期预后方面，PMT±CDT显著优于CDT±CT以及保守治疗。这些发现进一步支持在临床实践中，对于此类并发症患者，倾向于选择静脉内治疗方法。
