Hybrid treatment of deep venous thrombosis : Local fibrinolytic therapy, mechanical fragmentation, and clot aspiration.

即使在日本，深静脉血栓形成也是发病率和死亡率的常见来源。并发症包括肺血栓栓塞和慢性血栓后综合征。标准治疗包括抗凝药物治疗，但单独抗凝并不总能恢复静脉通畅，许多患者留下静脉流出道阻塞和瓣膜功能不全。因此，治疗深静脉血栓形成的侵入性血管内技术已经发展。导管直接溶栓是第一个证明有效的此类手术，但其接受程度受到感知风险、溶解时间和成本的限制。目的：探讨局部溶栓、机械溶栓和介入治疗相结合治疗重症下肢深静脉血栓（DVT）的有效性和安全性 ...更多信息 受试者和方法：45例深静脉血栓形成患者采用混合介入手术治疗。插入临时腔静脉滤器后，使用PTCA导引导管进行血栓抽吸和/或使用OASIS或改良旋转猪尾导管系统进行机械血栓切除术。如果需要，进行额外的球囊PTA/支架植入术和连续局部尿激酶治疗。主要终点是血栓取出的静脉造影结果。结果：42例患者均经股动脉介入治疗。同侧入路：22例，对侧：20例。介入技术如下：手动凝块抽吸术37例，OASIS血栓切除术13例，使用改良猪尾导管的机械血栓粉碎术3例，球囊PTA 3例，支架植入术4例，连续局部溶栓16例。42例患者中有37例成功再通。37例患者在插入后9.2天轻松取出临时腔静脉滤器。并发症：血胸1例，腹膜后血肿1例。结论：混合疗法是治疗深静脉血栓形成患者的一种治疗选择。少

Deep venous thrombosis is a common sourse of morbidity and mortality even in Japan. Complications include pulmonary thromboembolism and chronic post thrombotic syndrome. The standard treatment consists of medical management with anticoagulation, but anticoagulation alone does not always restore venous patency and many patients are left with venous outflow obstruction and valvular inconpetence. Aggressive endovascular techniques for managing deep venous thrombosis have evolved as a result. Catheter directed thrombolysis was the first such procedure with demonstrated efficacy, but its acceptance has been limited by perceived risks, time to lysis, and cost. As a result, alternative measures have evolved including percutaneous interventional procedure.After the experimental research, I started the clinical study of these interventional procedures.Objective : To evaluate the efficacy and safety of a hybrid treatment for severe deep venous thrombosis by combining local thrombolysis, mechanic … More al fragmentation, and clot aspiration.Subjects and methods : 45 patients with deep venous thrombosis were treated with hybrid interventional procedures. After insertion of a temporary vena cava filter, thrombo-aspiration with a PTCA guiding catheter and/or mechanical thrombectomy with OASIS or modified rotating pigtail catheter system were performed. Additional balloon PTA/stenting and continuous local urokinase therapy was performed, if needed. The primary endpoint was venographic findings of thrombus extraction. Systemic thrombolysis and anticoagration therapy followed.Results : Trans-femoral interventional radiological therapy was achieved in 42 patients. Approach was ipsilateral : 22, contralateral : 20. Interventional techniques were as followed : manual clot aspiration 37, OASIS thrombectomy 13, mechanical thrombus fragmentation using a modified pigtail catheter 3, balloon PTA 3, stenting 4, and continuous local thrombolysis 16. Successful recanalization was achieved in 37 out of 42 patients. A temporary vena caval filter was easily removed 9.2 days after the insersion in 37 patients. Complications : haemothorax 1, retroperitoneal hematoma 1.Conclusion : Hybrid treatments are a therapeutic option in patients presenting deep venous thrombosis. Less