AngioJet血栓抽吸术后髂股静脉支架植入对急性下肢深静脉血栓形成的疗效

Therapeutic effect of iliofemoral stenting after AngioJet rheolytic thrombectomy on acute deep vein thrombosis

目的·分析急性髂股静脉血栓(deep vein thrombosis,DVT)AngioJet吸栓治疗后行静脉支架植入术的临床疗效。方法·回顾性分析2015年1月到2016年12月上海交通大学医学院附属第九人民医院血管外科因髂股静脉DVT行AngioJet吸栓治疗后接受髂股静脉支架植入术的患者,分析技术成功率、1年通畅率及血栓后综合征(postthrombotic syndrome,PTS)发生率,并比较吸栓术后直接支架植入术和吸栓后分期支架植入术的疗效。结果·共纳入97例患者,其中直接支架植入组50例,分期支架植入组47例。溶栓吸栓治疗后植入支架的技术成功率为100%,无围手术期严重并发症发生。即时临床缓解率前者为92.0%,明显高于后者(68.1%,P=0.000)。12个月随访直接支架植入组通畅率为93.6%,分期支架植入组为97.8%,2组差异无统计学意义(P=0.323)。Villalta评分直接支架组高于分期支架组(4.21±2.37vs2.11±1.82,P=0.000)。结论·髂股静脉支架植入对于DVT后髂股静脉压迫/狭窄病变是一种有效的治疗手段,而支架植入的时机需根据患者基础情况和病变情况决定。

Objective · To evaluate the outcomes of patients with acute proximal deep vein thrombosis (DVT) and iliofemoral stenosis who underwent stenting after AngioJet rheolytic thrombectomy. Methods · A retrospective analysis was conducted on the patients who received iliofemoral vein stent implantation after the treatment of iliofemoral vein DVT with AngioJet thrombectomy from January 2015 to December 2016 in the Vascular Surgery Department of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. The outcomes included technical success rate, patency rate at 1 year and incidence rate of post thrombotic syndrome (PTS). The effect of direct stenting after AngioJet rheolytic thrombectomy was compared with that of staged stenting. Results · A total of 97 patients were enrolled and divided into direct stenting group (n=50) and staged stenting group (n=47). The technical success rates were 100% in both groups, and there was no 30-day mortality and serious complication. Immediate clinical improvement in direct group was significantly higher than that in staged group (92.0% vs 68.1%, P=0.000). The primary patency rates at 1 year were 93.6% in the direct group and 97.8% in the staged group (P=0.323). The Villalta scores in the direct group were significantly higher than those in the staged group (4.21±2.37 vs 2.11±1.82, P=0.000). Conclusion · Both direct and staged stenting are effective treatment modalities for patients with acute proximal DVT. The decision of the stenting timing should be based on individual case.