Clinical efficacy of one-stage thrombus removal via contralateral femoral and ipsilateral tibial venous access for pharmacomechanical thrombectomy in entire-limb acute deep vein thrombosis
Clinical efficacy of one-stage thrombus removal via contralateral femoral and ipsilateral tibial venous access for pharmacomechanical thrombectomy in entire-limb acute deep vein thrombosis
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DOI：
10.1016/j.jvsv.2021.01.007
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发表时间：
2021-08-13
影响因子：
3.2
通讯作者：
Ye, Meng
中科院分区：
文献类型：
--
作者：
Ni, Qihong;Long, Jianyun;Ye, Meng
目的：在本研究中，我们比较了药物机械血栓切除术（PMT）治疗全肢急性深静脉血栓形成（DVT）的不同方法之间的早期结果。方法：本回顾性队列研究包括2016年1月至2019年3月在两个独立的血管中心接受PMT的全肢急性DVT患者。在第一家中心（仁济医院），血管外科医生使用对侧股静脉入路或同侧胫骨静脉入路（CFVA/ITVA）。所有连续的全肢急性DVT患者均在第一家临床试验机构通过CFVA/ITVA接受PMT。在第二个中心（杭州市第一人民医院附属医院），血管外科医生使用传统方法通过同侧腘静脉通路（IPVA）进行PMT。所有连续患者均在第二家中心通过IPVA接受PMT。主要终点是血栓后综合征（PTS）的发生率。次要终点包括血栓清除等级、静脉一期通畅率和中重度PTS.Results的发生率：共有73例患者入组本研究，其中第一中心CFVA/ITVA患者37例，第二中心IPVA患者36例。两组在年龄、性别、发病时间、患肢、危险因素等方面均无显著性差异。CFVA/ITVA组接受导管溶栓治疗的患者比例显著低于IPVA组（P = 0.010）。CFVA/ITVA组实现III级血栓清除的频率高于IPVA组（P = .007）。CFVA/ITVA组的PTS发生率显著低于IPVA组（P = 0.043）。血栓清除分级和入路类型是与PTS发生相关的独立因素。血栓完全清除（III级）和CFVA/ITVA患者有一个显着降低PTS的发生率。结论：PMT可以提高血栓清除率，减少后续导管直接溶栓的要求，并可能降低PTS的发生率使用CFVA/ITVA，而不是传统的IPVA治疗全肢体急性DVT。
Objective: In the present study, we compared the early results between different approaches for pharmacomechanical thrombectomy (PMT) in the treatment of entire-limb acute deep vein thrombosis (DVT).Methods: The present retrospective cohort study included patients with entire-limb acute DVT who had undergone PMT from January 2016 to March 2019 at two independent vascular centers. At the first center (Renji Hospital), the vascular surgeons used contralateral femoral venous access or ipsilateral tibial venous access (CFVA/ITVA). All consecutive patients with entire-limb acute DVT had undergone PMT through CFVA/ITVA at the first center. At the second center (Affiliated Hangzhou First People's Hospital), the vascular surgeons had conducted PMT using the traditional approach via ipsilateral popliteal venous access (IPVA). All consecutive patients had undergone PMT through IPVA at the second center. The primary endpoint was the incidence of post-thrombotic syndrome (PTS). The secondary endpoints included thrombus removal grade, venous primary patency rate, and the incidence of moderate-to-severe PTS.Results: A total of 73 patients were enrolled in the present study, including 37 patients with CFVA/ITVA at the first center and 36 patients with IPVA at the second center. No significant difference was detected between the two groups in age, gender, onset time, affected limb, or risk factors. The proportion of patients who had undergone catheter-directed thrombolysis was significantly lower in the CFVA/ITVA group than in the IPVA group (P = .010). Thrombus removal grade III was achieved more often in the CFVA/ITVA group than in the IPVA group (P = .007). The PTS incidence was significantly lower in the CFVA/ITVA group than in the IPVA group (P = .043). The thrombus removal grade and access type were independent factors associated with the development of PTS. Patients with complete thrombus removal (grade III) and CFVA/ITVA had a significantly lower incidence of PTS.Conclusions: PMT can increase the thrombus clearance rate, reduce the requirement for subsequent catheter-directed thrombolysis, and, potentially, decrease the incidence of PTS using CFVA/ITVA instead of traditional IPVA in the treatment of entire-limb acute DVT.