AngioJet血栓清除装置一次性治疗急性下肢深静脉血栓形成的应用

Single-session protocol with AngioJet Device for treatment of acute deep vein thrombosis

目的初步研究采用AngioJet血栓清除装置及其辅助措施一次性治疗急性下肢深静脉血栓形成的可行性、安全性和有效性。方法回顾性分析2016年06月~2016年12月连续收治的急性下肢深静脉血栓形成患者18例。采用治疗方案:放置Aegisy可回收滤器,滤器释放后不予解脱,球囊导管对血栓段行扩张碎栓,AngioJet导管行血栓抽吸,若合并髂静脉狭窄则同期行球囊扩张,残余狭窄>50%时同期植入支架,血栓清除后即刻取出滤器,术后保留鞘管溶栓,24h造影复查。结果治疗过程中3例未置滤器,15例置入临时滤器,其中12例(12/15,80.0%)滤器同期取出,3例(3/15,20.0%)溶栓结束后取出。15例患者合并髂静脉狭窄,同期扩张后植入髂静脉支架16枚。所有患者均未放置溶栓导管。术后即刻血栓清除Ⅲ级13例(13/18,72%),Ⅱ级5例(5/18,28%),经鞘管溶栓后血栓清除Ⅲ级15例(15/18,83%),Ⅱ级3例(3/18,17%)。血栓平均抽吸时间(216.61±56.60)s,平均尿激酶用量(108.89±56.45)万U,平均溶栓时间(36.00±18.86)h。无症状性肺栓塞、严重出血以及其他严重并发症发生。随访时间6~11月,持续静脉通畅,无血栓复发。结论利用AngioJet血栓清除装置及其辅助措施一次性治疗急性下肢深静脉血栓形成是一种安全、有效的方法,简化了介入治疗过程,提高患者舒适度,具有潜在的缩短溶栓时间及减少用栓药物剂量、提高血栓清除效率等优势。

Objective We aim to evaluate the feasibility,safety,and effectiveness of single-session endovascular treatment with AngioJet Device for treatment of acute deep vein thrombosis.Methods 18 consecutive patients from Jun 2016 to Dec 2016 with acute proximal deep vein thrombosis were performed with single-session endovascular treatment.Endovascular treatment,consisting of IVC filter insertion and retrieval,balloon maceration,AngioJet rheolytic thrombectomy,balloon angioplasty,and stent placement,was performed in the same setting.Antegrade thrombolysis was performed for residual thrombus via sheath approach.Patient characteristics and outcomes data were collected.Results 3 cases were treated without filter placement,15 cases with filter protection,12 of 15 cases(80.0%)with filter retrieval in the same setting,3 of 15 with filter relief and retrieval after thrombolysis.16 iliac vein stents were placed in 15 cases in the single-session procedure.All patients needed no thrombolysis catheter.GradeⅢ(>99%)thrombus removal was achieved in 13 cases(72%),Ⅱin 5 cases(28%),while after thrombolysisⅢin 15 cases(83%),Ⅱin 3 cases(17%).Average thrombectomy time,dosage of urokinase and thrombolysis time was(216.61±56.60)seconds,(108.89±56.45)×10 4 U,and(36.00±18.86)hours.No symptomatic pulmonary embolization,major bleeding,or any other severe procedure-related complications were observed.No thrombosis recurrence occurred in 6~11 months follow-up.Conclusion Single-session protocol with AngioJet Device is a feasible,safe,and effective method for treatment of acute deep vein thrombosis,as simplyfing the procedure and comforting the treatment.This method may potentially reduce thrombolytic agents,thrombolytic time and increase thrombectomy efficiency.