Please wait a minute...
J Zhejiang Univ (Med Sci)  2018, Vol. 47 Issue (6): 595-600    DOI: 10.3785/j.issn.1008-9292.2018.12.05
    
Efficacy of percutaneous mechanical thrombectomy combined with percutaneous transluminal angioplasty in treatment of iliofemoral deep vein thrombosis
LIN Zuodong(),LANG Dehai*()
Department of Vascular Surgery, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang Province, China
Download: HTML( 3 )   PDF(1265KB)
Export: BibTeX | EndNote (RIS)      

Abstract  

Objective: To evaluate the clinical efficacy of percutaneous mechanical thrombectomy (PMT) combined with percutaneous transluminal angioplasty (PTA) in the treatment of iliofemoral deep vein thrombosis. Methods: Ninety-four patients with iliofemoral deep vein thrombosis were identified in this retrospective study in our institution from November 2015 through December 2017. Patients were divided into two groups:PMT+PTA group (n=50) and PMT only group (n=44). Clot lysis rates, the retrieving and the embolism of the interior vena cava filter, as well as the incidence of complications were compared between two groups. The changes of serum creatinine, lactate dehydrogenase and hemoglobin were also measured perioperatively. Results: All procedures were completed successfully. The average clot lysis rate was higher and the procedure time was shorter in PMT+PTA group than those in PMT group (both P < 0.01). No significant differences were found in the rates of venous stenosis, catheter-directed thrombolysis and stent placement between two groups (all P>0.05). The interior vena cava filter was taken out in 82.0% (41/50) patients of PMT+PTA group and 81.8% (36/44) patients of PMT group (P>0.05). There were no significant differences of the changes in serum creatinine, lactate dehydrogenase and hemoglobin (all P>0.05). In PMT+PTA group, symptomatic pulmonary embolism and puncture bleeding occurred in 1(2.0%) and 2(4.0%) patients, while in PMT group, it was 0 and 2(4.5%), respectively (P>0.05). Conclusion: PMT combined with PTA is more effective than PMT alone for the treatment of iliofemoral deep vein thrombosis with less procedure time and without more incidence of pulmonary embolism.



Key wordsVenous thrombosis/therapy      Femoral vein      Iliac vein      Thrombectomy      Balloon dilatation      Combined modality therapy      Treatment outcome     
Received: 05 July 2018      Published: 15 March 2019
CLC:  R654  
  R364.1+5  
Corresponding Authors: LANG Dehai     E-mail: linzuodong1989@163.com;13738868758@139.com
Cite this article:

LIN Zuodong,LANG Dehai. Efficacy of percutaneous mechanical thrombectomy combined with percutaneous transluminal angioplasty in treatment of iliofemoral deep vein thrombosis. J Zhejiang Univ (Med Sci), 2018, 47(6): 595-600.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2018.12.05     OR     http://www.zjujournals.com/med/Y2018/V47/I6/595


经皮机械血栓清除联合球囊血管成形治疗髂股静脉血栓形成患者疗效分析

目的: 评价经皮机械血栓清除(PMT)联合球囊血管成形(PTA)治疗髂股静脉血栓形成患者的临床疗效。方法: 回顾性分析2015年11月至2017年12月于宁波市第二医院血管外科住院治疗的94例髂股静脉血栓形成患者的临床资料,根据吸栓前是否联合PTA分为PMT+PTA组(50例)和单纯PMT组(44例),比较两组的疗效,下腔静脉滤器取出及栓塞情况,治疗前后血清肌酐、乳酸脱氢酶、血红蛋白的变化,以及症状性肺栓塞、腘窝穿刺点出血等并发症的发生情况。结果: 所有患者均顺利完成手术。PMT+PTA组平均血栓清除率较单纯PMT组高,吸栓时间较PMT组短(均P < 0.01),但两组间髂股静脉狭窄率、支架植入率及辅助导管直接溶栓率差异均无统计学意义(均P>0.05)。两组下腔静脉滤器取出率分别为82.0%(41/50)和81.8%(36/44),差异无统计学意义(P>0.05)。两组术后血清肌酐、乳酸脱氢酶、血红蛋白变化差异均无统计学意义(均P>0.05)。PMT+PTA组术后发生症状性肺栓塞1例(2.0%),腘窝穿刺点出血2例(4.0%);单纯PMT组未发现症状性肺栓塞者,腘窝穿刺点出血的发生率为4.5%(2/44),与PMT+PTA组差异无统计学意义(P>0.05)。结论: PMT联合PTA治疗髂股静脉血栓形成不仅缩短了吸栓时间、血栓清除效果更好,同时不增加肺栓塞发生率,值得临床推广应用。


关键词: 静脉血栓形成/治疗,  股静脉,  髂静脉,  血栓切除术,  气囊扩张术,  综合疗法,  治疗结果 
[$\bar x \pm s$或n(%)]
组别 n 年龄(岁) 性别(男/女) 病程(d) 患肢侧(左/右) 吸烟史 高血压史 糖尿病史 肿瘤史 手术史 同侧血栓史 术前血清肌酐(μmol/L) 术前乳酸脱氢酶(IU/L) 术前血栓评分
—:无相关数据; PMT:经皮机械血栓清除;PTA:球囊血管成形.
单纯PMT组 44 59±14 21/23 6±3 39/5 11(25.0) 17(38.6) 4(9.0) 5(11.4) 13(29.5) 5(11.4) 69±27 229±60 10.7±2.6
PMT+PTA组 50 62±17 15/35 8±6 47/3 9(18.0) 20(40.0) 5(10.0) 5(10.0) 14(28.0) 7(14.0) 62±17 235±57 10.3±2.4
t/χ2 0.706 3.112 1.112 0.865 0.685 0.018 0.220 0.046 0.324 0.146 -1.246 0.452 0.194
P >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
Tab 1 Demographic and clinical characteristics of two groups
[$\bar x \pm s$或n(%)]
组别 n 吸栓时间(s) 血栓清除率(%) 血栓清除程度(Ⅰ/Ⅱ/Ⅲ) 髂股静脉狭窄 支架植入 辅助导管直接溶栓
—:无相关数据;PMT:经皮机械血栓清除术;PTA:球囊血管成形术.
单纯PMT组 44 282±95 77±15 1/35/8 35(79.5) 34(77.3) 28(63.6)
PMT+PTA组 50 223±74 87±11 0/36/14 45(90.0) 43(86.0) 34(68.0)
t/χ2 -3.408 3.589 2.277 2.018 1.203 0.198
P <0.01 <0.01 >0.05 >0.05 >0.05 >0.05
Tab 2 Clinical outcomes of the two groups
Fig 1 The perioperative venographs of a typical case recieved percutaneous mechanical thrombectomy combined with percutaneous transluminal angioplasty
[1]   COMEROTA A J , GREWAL N , MARTINEZ J T et al. Post thrombotic morbidity correlates with residual thrnmbus following catheter-directed thrombolysis for iliofemoral deep vein thrombosis[J]. J Vasc Surg, 2012, 55 (3): 768- 773
doi: 10.1016/j.jvs.2011.10.032
[2]   LIN P H , ZHOU W , DARDIK A et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis[J]. Am J Surg, 2006, 192 (6): 782- 788
doi: 10.1016/j.amjsurg.2006.08.045
[3]   MEWISSEN M W , SEABROOK G R , MEISSNER M H et al. Catheter-directed thrombolysis for lower extremity deep venous thrombosis:report of a national multicenter registry[J]. Radiology, 1999, 211 (1): 39- 49
[4]   KIM H S , PATRA A , PAXTON B E et al. Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis:clinical and economic outcomes[J]. J Vasc Interv Radiol, 2006, 17 (7): 1099- 1104
doi: 10.1097/01.RVI.0000228334.47073.C4
[5]   KIM H S , PATRA A , PAXTON B E et al. Catheter-directed thrombolysis with percutaneous rheolytic thrombectomy versus thrombolysis alone in upper and lower extremity deep vein thrombosis[J]. Cardiovasc Intervent Radiol, 2006, 29 (6): 1003- 1007
doi: 10.1007/s00270-005-0341-4
[6]   GARCIA M J , LOOKSTEIN R , MALHOTRA R et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy:final report of the prospective multicenter PEARL (Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths) registry[J]. J Vasc Interv Radiol, 2015, 26 (6): 777- 785
doi: 10.1016/j.jvir.2015.01.036
[7]   MORROW K L , KIM A H , PLATO S A et al. Increased risk of renal dysfunction with percutaneous mechanical thrombectomy compared with catheter-directed thrombolysis[J]. J Vasc Surg, 2017, 65 (5): 1460- 1466
doi: 10.1016/j.jvs.2016.09.047
[8]   李智, 倪才方, 金泳海 et al. 球囊扩张辅助经导管直接溶栓治疗急性下肢深静脉血栓[J]. 中华放射学杂志, 2012, 46 (6): 561- 566
LI Zhi , NI Caifang , JIN Yonghai et al. Balloon-assisted catheter directed thrombolysis for acute lower extremity deep vein thrombosis[J]. Chinese Journal of Radiology, 2012, 46 (6): 561- 566
doi: 10.3760/cma.j.issn.1005-1201.2012.06.018
[9]   黄献琛, 陈万海, 李春荣 et al. 介入治疗急性左髂股静脉血栓——先溶栓或先扩张[J]. 介入放射学杂志, 2011, 20 (9): 688- 691
HUANG Xianchen , CHEN Wanhai , LI Chunrong et al. Thrombolysis together with vascular dilatation for the treatment of acute left iliofemoral venous thrombosis:which procedure should be carried out first?[J]. Journal of Interventional Radiology, 2011, 20 (9): 688- 691
doi: 10.3969/j.issn.1008-794X.2011.09.006
[10]   《血管与腔内血管外科杂志》编辑部, 下肢静脉疾病外科治疗专家协作组 . AngioJet机械血栓清除术治疗急性下肢深静脉血栓形成的专家共识(2016版)[J]. 血管与腔内血管外科杂志, 2017, 3 (1): 555- 558
Editorial department of Journal of Vascular and Endovascular Surgery , The panel of Venous diseases of lower extremity surgical treatment specialists . Recommendations of percutaneous mechanical thrombectomy in the treatment of acute deep vein thrombosis of lower extremity(2016 Edition)[J]. Journal of Vascular and Endovascular Surgery, 2017, 3 (1): 555- 558
[11]   PORTER J M , MONETA G L . Reporting standards in venous disease:an update. International consensus committee on chronic venous disease[J]. J Vasc Surg, 1995, 21 (4): 635- 645
doi: 10.1016/S0741-5214(95)70195-8
[12]   ARSLAN B , TURBA U C , MATSUMOTO A H . Acute renal failure associated with percutaneous mechanical thrombectomy for iliocaval venous thrombosis[J]. Semin Intervent Radiol, 2007, 24 (3): 288- 295
doi: 10.1055/s-2007-985736
[1] WANG Xiaohui,HE Yangyan,WU Ziheng,ZHANG Hongkun. Efficacy of integrated minimally invasive treatment for iliac vein compression syndrome with varicose veins of lower extremities[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 577-582.
[2] YU Zuanbiao,LIN Zuodong,LANG Dehai. Long-term efficacy of percutaneous mechanical thrombectomy combined with stent implantation in treatment of acute iliofemoral venous thrombosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 623-627.
[3] SHEN Hong,JI Feng. Efficacy and safety of digestive tract stent placement under direct visual endoscopy without X-ray monitoring in treatment of digestive tract stricture[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 643-650.
[4] YIN Xiaoliang,LANG Dehai,WANG Di. Comparison of mechanical thrombectomy with transcatheter thrombolysis for acute iliac femoral venous thrombosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 588-594.
[5] DENG Xuan,HE Hanqing,ZHOU Yang,PAN Jinren,YAN Rui,TANG Xuewen,FU Jian. Economic evaluation of different chickenpox vaccination strategies[J]. J Zhejiang Univ (Med Sci), 2018, 47(4): 374-380.
[6] XU Weize,YE Jingjing,LI Jianhua,ZHANG Zewei,YU Jiangen,SHI Zhuo,YU Jin,SHU Qiang. Efficacy of percutaneous atrial septal defect closure guided by transesophageal echocardiography in children[J]. J Zhejiang Univ (Med Sci), 2018, 47(3): 244-249.
[7] ZHANG Yuxi,MO Xuming,SUN Jian,PENG Wei,QI Jirong,WU Kaihong,SU Yaqin. Application of thoracoscopic surgery in repairing esophageal atresia type Ⅲ with tracheoesophageal fistula in neonates[J]. J Zhejiang Univ (Med Sci), 2018, 47(3): 266-271.
[8] ZHANG Shisong,WU Yurui,LIU Hongzhen,ZHAI Yunpeng,LIU Wei. Experience in treatment of complex congenital intestinal atresia in children[J]. J Zhejiang Univ (Med Sci), 2018, 47(3): 255-260.
[9] LYU Chengjie,HU Donglai,HUANG Shoujiang,QIN Qi,ZHAO Xiaoxia,HU Shuqi,ZHANG Yanan,FANG Xuan,GUO Xiaodong,TOU Jinfa. Transumbilical single-site laparoscopic surgery for congenital duodenal obstruction in neonates[J]. J Zhejiang Univ (Med Sci), 2018, 47(3): 261-265.
[10] ZHU Ziyi,LI Zhijun,HE Zhengfu,WANG Yunzhen. Endoscopic trans-fistula drainage for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy[J]. J Zhejiang Univ (Med Sci), 2017, 46(6): 637-642.
[11] LU Wei,LIN Mengna,ZHAO Shifang,WANG Huiming,HE Fuming. Application of modified lateral window for maxillary sinus floor augmentation[J]. J Zhejiang Univ (Med Sci), 2017, 46(6): 630-636.
[12] ZHANG Siying, CHEN Feng. Research progress of CT/MRI parametric response map in precision evaluation of therapeutic response of cancer patients[J]. J Zhejiang Univ (Med Sci), 2017, 46(5): 468-472.
[13] PAN Jingying, HE Mengye, KE Wei, HU Menglin, WANG Meifang, SHEN Peng. Advances on correlation of PET-CT findings with breast cancer molecular subtypes, treatment response and prognosis[J]. J Zhejiang Univ (Med Sci), 2017, 46(5): 473-480.
[14] ZOU Lixia, LU Meiping, GUO Li, TENG Liping, XU Yiping, ZHENG Qi. Efficacy and safety of humanized interleukin-6 receptor antibody in treatment of systemic juvenile idiopathic arthritis[J]. J Zhejiang Univ (Med Sci), 2017, 46(4): 421-426.
[15] ZHANG Meixia, ZHOU Ying, ZHANG Ruiting, ZHANG Sheng, LOU Min. Maximal infarct volume to benefit from intravenous thrombolysis and its relation with onset to treatment time[J]. J Zhejiang Univ (Med Sci), 2017, 46(4): 384-389.