Correlation between Post-Procedure Residual Thrombus and Clinical Outcome in Deep Vein Thrombosis Patients Receiving Pharmacomechanical Thrombolysis in a Multicenter Randomized Trial.
Correlation between Post-Procedure Residual Thrombus and Clinical Outcome in Deep Vein Thrombosis Patients Receiving Pharmacomechanical Thrombolysis in a Multicenter Randomized Trial.
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DOI：
10.1016/j.jvir.2020.07.010
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Vedantham S
中科院分区：
文献类型：
--
作者：
Razavi MK;Salter A;Goldhaber SZ;Lancia S;Kahn SR;Weinberg I;Kearon C;Azene EM;Patel NH;Vedantham S
目的评价药物机械导管定向静脉溶栓(PCDT)后即刻静脉造影结果与临床结果的关系。在一项多中心随机试验中，对接受经皮冠状动脉腔内成形术(PCDT)治疗的317例急性近端DVT患者的静脉造影进行了回顾。血栓的定量消退由独立读者使用改良的Marder分级进行评估。内科医生记录了他们对血栓消退和静脉血流的视觉评估。术后即刻的结果与术后1、12和24个月的患者预后相关。经皮冠状动脉腔内成形术有显著的血栓清除作用(所有节段经皮冠状动脉腔内成形术前与成形术后血栓评分相比，P<；0.001)。手术结束时，99%的髂股静脉段和89%的股静脉段存在自发性静脉血流。对于整个近端DVT人群和股-股静脉DVT亚组，PTDT后血栓体积与1个月或24个月的预后无关。对于髂股深静脉血栓亚组，术后1个月和24个月血栓体积越大，症状严重程度评分越高(恶化)，静脉疾病特有的生活质量评分越低(恶化)，24个月的血栓形成严重程度差异有统计学意义(p=0.0098)。PTDT术后血栓体积与12个月瓣膜返流无关。PCDT成功地清除了急性近端DVT的血栓。然而，手术结束时的残余血栓负荷与随后24个月内PTS的发生无关。在髂股深静脉血栓中，较低的残余血栓负荷与PTS严重程度的降低相关，也可能与静脉生活质量的改善和早期症状的减少相关。
To evaluate relationships between immediate venographic results and clinical outcomes of pharmacomechanical catheter-directed venous thrombolysis (PCDT). Venograms from 317 acute proximal DVT patients who received PCDT in a multicenter randomized trial were reviewed. Quantitative thrombus resolution was assessed by independent readers using a modified Marder scale. The physician operators recorded their visual assessments of thrombus regression and venous flow. These immediate post-procedure results were correlated with patient outcomes at 1, 12, and 24 months. PCDT produced substantial thrombus removal (p < 0.001 for pre-PCDT versus post-PCDT thrombus scores in all segments). At procedure end, spontaneous venous flow was present in 99% of iliofemoral venous segments and in 89% of femoral-popliteal venous segments. For the overall proximal DVT population, and for the femoral-popliteal DVT subgroup, post-PCDT thrombus volume did not correlate with 1-month or 24-month outcomes. For the iliofemoral DVT subgroup, over 1 and 24 months, symptom severity scores were higher (worse) and venous disease-specific quality of life (QOL) scores were lower (worse) in patients with greater post-PCDT thrombus volume, with the difference reaching statistical significance for the 24-month Villalta PTS severity (p=0.0098). Post-PCDT thrombus volume did not correlate with 12-month valvular reflux. PCDT successfully removes thrombus in acute proximal DVT. However, the residual thrombus burden at procedure end does not correlate with the occurrence of PTS during the subsequent 24 months. In iliofemoral DVT, lower residual thrombus burden correlates with reduced PTS severity and possibly also with improved venous QOL and fewer early symptoms.
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DOI：
10.1056/nejmoa1615066
发表时间：
2017-12-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
Vedantham S;Goldhaber SZ;Julian JA;Kahn SR;Jaff MR;Cohen DJ;Magnuson E;Razavi MK;Comerota AJ;Gornik HL;Murphy TP;Lewis L;Duncan JR;Nieters P;Derfler MC;Filion M;Gu CS;Kee S;Schneider J;Saad N;Blinder M;Moll S;Sacks D;Lin J;Rundback J;Garcia M;Razdan R;VanderWoude E;Marques V;Kearon C;ATTRACT Trial Investigators
通讯作者：
ATTRACT Trial Investigators
DOI：
10.1097/01.rvi.0000197359.26571.c2
发表时间：
2006-03-01
影响因子：
2.9
作者：
Vedantham, S;Grassi, CJ;Sacks, D
通讯作者：
Sacks, D
影响因子：
19.7
作者：
Mewissen, MW;Seabrook, GR;Haughton, SH
通讯作者：
Haughton, SH
DOI：
10.1016/j.jvir.2014.04.019
发表时间：
2014-09-01
影响因子：
2.9
作者：
Vedantham, Suresh;Sista, Akhilesh K.;Nikolic, Boris
通讯作者：
Nikolic, Boris
影响因子：
10.4
作者：
Kahn, S. R.;Shbaklo, H.;Ginsberg, J. S.
通讯作者：
Ginsberg, J. S.