滤器源性腔-髂静脉血栓形成的介入治疗:AngioJet血栓清除术与大腔导管抽吸术的疗效比较

Evaluation of the Efficacy of Mechanical Thrombectomy and AngioJet Thrombectomy in the Treatment of the Inferior Vena Cava Filter Related IVC-iliac Vein Thrombosis

目的探讨AngioJet流变式血栓清除术与大腔导管抽吸术在治疗滤器源性腔-髂静脉血栓中的疗效及安全性。方法搜集2018年3月至2020年3月23例急性滤器源性下腔静脉-髂静脉血栓患者,行导管接触性溶栓治疗后均效果不佳,并行经皮机械性血栓清除术。其中大腔导管抽吸组12例,AngioJet机械性血栓清除组11例。对两组在血栓清除程度、并发症发生率以及随访情况进行对比分析。结果患者接受经皮机械性血栓清除术治疗后患肢肿胀明显缓解,大腔导管抽吸组治疗前后的患肢周径差分别为(4.7±2.6) cm和(2.3±1.6) cm(P<0.05),AngioJet组治疗前后的患肢周径差分别为(3.5±2.1) cm和(1.7±1.1) cm(P<0.05)。AngioJet组能减少术后阿替普酶(rt-PA)的用量(P<0.05),且血栓清除率高于大腔导管抽吸组(P<0.05);两种方法治疗过程中均无严重并发症发生。结论大腔导管抽吸和AngioJet血栓清除术对滤器源性下腔静脉-髂静脉血栓均有较好的清除作用,但AngioJet血栓清除可减少rt-PA剂量,提高血栓清除率。

Objective To compare the efficacy and safety of AngioJet thrombectomy and mechanical thrombectomy in the treatment of inferior vena cava Filter related IVC-iliac vein thrombosis. Methods The clinical data and medical imaging materials of 23 cases with acute Inferior Vena Cava Filter related IVC-iliac vein thrombosis from March 2018 to March 2020 in Nanjing First Hospital, Nanjing Medical University, including 12 cases of mechanical thrombectomy group and 11 cases of AngioJet thrombectomy group.The final thrombolysis rate, the incidence of complications, and the follow-up were evaluated. Results The limb swelling was significantly relieved in patients with PMT after treatment.The peri-diameter difference of the limb in the mechanical thrombectomy group before and after treatment was [(4.7±2.6)cm vs.(2.3±1.6)cm, P< 0.05], and that in the AngioJet group before and after treatment was [(3.5±2.1)cm vs.(1.7±1.1)cm, P< 0.05],respectively. The amount of postoperative rt-PA is reduced in AngioJet group [(62.0±25.7)mg vs.(96.4±42.5)mg, P< 0.05], and the thrombolysis rate was higher than that of the mechanical thrombectomy group [(86.7%±10.9%) vs.(67.4%±24.0%),P< 0.05].No serious complications occurred during the treatment. Conclusion Both mechanical thrombectomy and AngioJet thrombectomy have good thrombosis clearance effects on Inferior Vena Cava Filter related IVC-iliac vein thrombosis.AngioJet thrombectomy can reduce the rt-PA dose and increase the thrombolysis rate.