AngioJet机械吸栓联合导管溶栓在治疗下肢深静脉血栓形成中的应用体会

Application of AngioJet Pharmacomechanical Thrombectomy Combined with Catheter-Directed Thrombolysis in the Treatment of Deep Venous Thrombosis of Lower Extremities

目的总结AngioJet机械吸栓联合导管接触溶栓在治疗下肢深静脉血栓的应用体会。方法回顾性分析2018年5月-2019年5月采用AngioJet机械吸栓联合导管接触溶栓治疗的63例下肢深静脉血栓患者的临床资料(急性期51例,亚急性期12例;髂股型44例,股腘型19例),观察患者临床症状的改善情况,计算即时血栓清除率,并对下肢静脉通畅率进行评分,评价联合溶栓的安全性及有效性。结果63例患者均顺利完成治疗,技术成功率100%,围术期均未出现严重出血等并发症。术后均出现肉眼血尿,但均于(15.46±3.23)h内消失,无肾功能受损表现。63例患者症状均得到有效缓解,治疗前后患侧与健侧大腿周径差分别为(5.35±2.37)及(0.35±0.59)cm,差别有统计学意义(t=9.46,P<0.05);小腿周径差分别为(4.10±0.91)及(0.75±0.64)cm,差别有统计学意义(t=13.18,P<0.05);静脉通畅评分分别为(12.95±5.15)及(2.90±3.99)分,差别有统计学意义(Z=-3.92,P<0.05)。AngioJet机械吸栓术后即时造影总体即时静脉通畅率为(80.68±19.50)%,联合导管接触溶栓后静脉通畅率提高到(89.85±12.75)%,差别有统计学意义(t=-6.45,P<0.01)。即时血栓清除达Ⅲ级且仅残留髂总静脉重度狭窄/闭塞的23例患者中,21例行一期髂静脉支架开通。在年龄、性别、病变范围及血栓清除量无明显差别的情况下,急性期的即时血栓清除率明显优于亚急性期(P<0.05)。患者随访(11.3±3.84)个月(≥6个月),深静脉血栓复发4例(恶性肿瘤晚期1例,家族性易栓症3例),随访6个月时总体静脉通畅率(84.16±21.06)%。结论采用AngioJet机械吸栓联合导管接触溶栓治疗下肢深静脉血栓快速、安全、有效,急性期疗效较亚急性期好。血栓清除达Ⅲ级且仅残留左髂静脉重度狭窄/闭塞的患者可行一期髂静脉支架成形术,短期疗效满意。

Objective To summarize the experience of AngioJet pharmacomechanical thrombectomy combined with catheter-directed thrombolysis for the treatment of deep venous thrombosis of lower extremities.Methods The clinical data of 63 patients with deep venous thrombosis of lower extremity treated with AngioJet pharmacomechanical thrombectomy combined with catheter-directed thrombolysis were analyzed retrospectively from May 2018 to May 2019.There were 51 cases in acute phase and 12 cases in subacute phase.44 cases were iliofemoral deep venous thrombosis and 19 cases were femoropopliteal deep venous thrombosis.The safety and effectiveness of the method were evaluated by observing the improvement of clinical symptoms and the immediate thrombus clearance rate of the intraoperative angiography and the venous patency rate of the lower extremities.Results All patients successfully completed treatment with a technical success rate of 100%.No major bleeding complications occurred during the perioperative period.All patients developed gross hematuria after surgery and disappeared at(15.46±3.23)hours without renal dysfunction.The symptoms of all patients were effectively relieved.The difference in thigh circumferential diameter between the affected side and the healthy side was(5.35±2.37)cm and(0.35±0.59)cm,respectively.The difference was statistically significant(t=9.46,P<0.05);the calf circumference diameter differences were(4.10±0.91)cm and(0.75±0.64)cm,respectively,and the difference was statistically significant(t=13.18,P<0.05).The venous patency scores were(12.95±5.15)and(2.90±3.99),respectively.The difference was statistically significant(Z=-3.92,P<0.05).The overall immediate venous patency rate was(80.68±19.50)%after AngioJet pharmacomechanical thrombectomy.The overall venous patency rate was(89.85±12.75)%after combined catheter contact thrombolysis,and the difference was statistically significant(t=-6.45,P<0.01).One-stage iliac vein stenting was performed in 21 of 23 cases with gradeⅢimmediate thrombosis removal and only severe stenosis/occlusion of the common iliac vein of after pharmacomechanical thrombectomy.In the case of no significant difference in gender,age,thrombus range and thrombus clearance,the immediate thrombus clearance rate in the acute phase group was significantly better than that in the subacute phase group(P<0.05).All 63 patients completed at least 6 months of follow-up,with an average follow-up of(11.3±3.84)months,4 cases of deep venous thrombosis recurred,one was diagnosed with advanced malignant tumors,and the other three were patients with hereditary thrombophilia,and the remaining 59 cases without thrombus recurrence.The overall venous patency rate reached(84.16±21.06)%at 6 months.Conclusion AngioJet pharmacomechanical combined with catheter-directed thrombolysis is a rapid,safe and effective method for the treatment of deep venous thrombosis of lower extremities.The effect is more ideal in acute thrombosis.Patients with thrombus clearance up to gradeⅢand only left iliac vein occlusion can undergo one-stage iliac vein stenting with satisfactory short-term results.