Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis: Clinical and economic outcomes
Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis: Clinical and economic outcomes
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DOI：
10.1097/01.rvi.0000228334.47073.c4
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发表时间：
2006-07-01
影响因子：
2.9
通讯作者：
Streiff, Michael B.
中科院分区：
文献类型：
--
作者：
Kim, Hyun S.;Patra, Ajanta;Streiff, Michael B.
目的：评估单独导管溶栓（CDT）与CDT联合流变性经皮机械取栓（PMT）治疗下肢深静脉血栓（DVT）的临床和经济效益。材料和方法：1997年至2003年间连续接受尿激酶CDT治疗的急性髂股深静脉血栓患者。比较单独CDT治疗与CDT + PMT治疗患者的人口学特征、临床和经济结果。结果：23例患者中26例肢体接受尿激酶CDT治疗，14例患者中19例肢体接受CDT + PMT治疗。CDT的平均治疗时间为56.5 +/- 27.4小时，而CDT + PMT的平均治疗时间为30.3 +/- 17.8小时（P =.001）。CDT的平均尿激酶剂量为6.70 +/- 590万U，而CDT + PMT的平均尿激酶剂量为2.95 +/- 182万U （P = 0.011）。尿激酶CDT在80.7%的肢体（n = 21）中实现了完全的凝块溶解，而CDT + PMT治疗的肢体（n = 16）为84.2% （P = 764）。大出血（CDT, 7.7%; CDT + PMT, 5.3%, P =.749）和肺栓塞（CDT, 3.8%; CDT + PMT, 5.3%, P =.818）的发生率相似。单独CDT的尿激酶和PMT设备的平均成本为10,127美元，而CDT加PMT的平均成本为5,128美元（P = 0.026）。结论：经皮CDT联合溶血性PMT治疗急性髂股深静脉血栓的效果与单纯CDT治疗一样，但治疗时间明显缩短，溶栓剂剂量明显降低，成本更低。随机研究证实药物力学溶栓治疗深静脉血栓的益处是必要的。
PURPOSE: To assess the clinical and economic benefits of catheter-directed thrombolysis (CDT) alone versus CDT with rheolytic percutaneous mechanical thrombectomy (PMT) for lower-extremity deep vein thrombosis (DVT).MATERIALS AND METHODS: Consecutive patients with acute iliofemoral DVT treated with CDT with urokinase between 1997 and 2003 were identified. Demographic characteristics and clinical and economic outcomes were compared between patients treated with CDT alone versus CDT plus PMT.RESULTS: Twenty-six limbs in 23 patients received CDT with urokinase, whereas 19 limbs in 14 patients were treated with CDT plus PMT. Mean treatment duration for CDT was 56.5 +/- 27.4 hours, compared with 30.3 +/- 17.8 hours for CDT plus PMT (P =.001). Mean urokinase dose for CDT was 6.70 +/- 5.9 million U compared with 2.95 +/- 1.82 million U for CDT plus PMT (P =.011). Urokinase CDT achieved complete clot lysis in 80.7% of limbs (n = 21) compared with 84.2% of limbs (n = 16) treated with CDT plus PMT (P =.764). The incidences of major bleeding (CDT, 7.7%; CDT plus PMT, 5.3%; P =.749) and pulmonary embolism (CDT, 3.8%; CDT plus PMT, 5.3%; P =.818) were similar. The mean urokinase and PMT device cost for CDT alone was $10,127 compared with $5,128 for CDT plus PMT (P =.026).CONCLUSIONS: Percutaneous CDT with rheolytic PMT is as effective as CDT alone for acute iliofemoral DVT but requires significantly shorter treatment and lower lytic agent dose, resulting in lower costs. Randomized studies to confirm the benefits of pharmacomechanical thrombolysis in the treatment of DVT are warranted.