Thrombus Extension after Great Saphenous Vein Mechanochemical Ablation.
Thrombus Extension after Great Saphenous Vein Mechanochemical Ablation.
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DOI：
10.1016/j.avsg.2021.03.015
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发表时间：
2021-08
影响因子：
1.5
通讯作者：
Woo K
中科院分区：
文献类型：
--
作者：
Rebuffatti M;Chan K;Woo K
研究机械化学消融早期经验后与血栓扩展相关的因素，机械化学消融结合了静脉内皮的机械损伤和硬化剂输注。对接受机械化学消融术治疗大腿隐静脉功能不全（包括隐股交界处）的患者进行了回顾性分析。提取的数据包括患者人口统计学、手术细节和术后结局。通过术后多普勒超声确定血栓延伸，并将其分类为与股静脉齐平闭合和血栓延伸至股静脉。73例患者符合入选标准。人群的平均年龄为60岁，17.8%为女性，平均BMI为30.7。7例（9.6%）接受机械化学消融的患者发生隐静脉闭合与股静脉齐平。11例（15%）患者发生血栓延伸至股静脉直径的50%以下，1例患者发生股静脉完全血栓形成。除体重指数（BMI）外，血栓扩展组和无血栓扩展组之间的年龄、性别或慢性静脉疾病综合分类系统（CEAP）无显著差异。血栓扩展组的平均BMI为26.8，无血栓扩展组为32（p=0.02）。两组在硬化剂用量、导管尖端与SFJ之间的距离以及大腿GSV的平均直径方面无显著差异。在该队列中，与报告的热消融率相关的血栓延伸率相比，机械化学消融术后血栓延伸至股静脉的发生率较高。需要对更大的队列进行进一步研究，并进行标准化报告，以表征机械化学消融后血栓延伸的真实率，并确定可能防止血栓延伸的操作。
To examine factors associated with thrombus extension after early experience with mechanochemical ablation, which combines mechanical damage to the venous endothelium with infusion of a sclerosant. A retrospective review was performed of patients who underwent mechanochemical ablation to treat saphenous vein insufficiency in the thigh including the saphenofemoral junction. Data abstracted included patient demographics, procedural details, and post-procedural outcomes. Thrombus extension was determined by post-procedural duplex ultrasound and classified as flush closure with the femoral vein and any extension of thrombus into the femoral vein. 73 patients met inclusion criteria. The mean age of the population was 60, 17.8% were female, and the mean BMI was 30.7. Seven (9.6%) patients who underwent mechanochemical ablation experienced saphenous vein closure flush with the femoral vein. Eleven (15%) patients experience extension of thrombus to less than 50% of the diameter of the femoral vein and one patient experienced complete thrombosis of the femoral vein. There was no significant difference in age, sex, or comprehensive classification system for chronic venous disorders (CEAP) between the group with thrombus extension and the group without, with the exception of body mass index (BMI). The mean BMI in the group with thrombus extension was 26.8 vs 32 in the group without (p=0.02). There was no significant difference between the two groups in sclerosant volume used, distance between catheter tip and SFJ, and mean diameter of GSV in the thigh. In this cohort, the incidence of thrombus extension into the femoral vein with mechanochemical ablation was high relative to rates of thrombus extension associated with reported rates of thermal ablation. Further investigation with larger cohorts, and standardized reporting is required to characterize the true rate of thrombus extension after mechanochemical ablation and identify maneuvers which may prevent thrombus extension.
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