导管吸栓联合导管接触性溶栓治疗早期下腔静脉滤器相关血栓形成的疗效及安全性

Efficacy and safety of catheter aspiration combined with catheter-directed thrombolysis in the treatment of early inferior vena cava filter-associated thrombosis

目的探讨导管吸栓联合导管接触性溶栓(CDT)对早期下腔静脉滤器相关血栓形成(IVCFT)的疗效及安全性。方法收集2019年1月至2021年9月于河北省人民医院行下腔静脉滤器取出术过程中发现的25例早期IVCFT患者的临床资料,依据治疗方式不同将患者分为吸栓组(n=15,给予导管吸栓联合CDT治疗)和单纯抗凝组(n=10,仅给予单纯抗凝治疗)。记录两组患者的滤器取出情况、吸栓前后血红蛋白水平的变化、尿激酶用量、溶栓时间、相关并发症[血管鞘周围渗血、肺动脉栓塞(PE)、大出血、重要脏器出血、下腔静脉损伤]发生情况。比较两组患者出院后不同时间(出院后1、3、6、12个月)深静脉血栓后综合征(PTS)的发生情况。结果吸栓组中2例患者经导管吸栓后一期取出滤器,13例患者行导管吸栓联合CDT治疗,滤器取出成功率为100%;单纯抗凝组的滤器取出成功率为20%。吸栓组患者的中位溶栓时间为30(25,50)h,中位尿激酶用量为78(71,150)万U。吸栓组中,5例患者在溶栓过程中发生血管鞘周围渗血;所有患者均无PE、大出血、重要脏器出血、下腔静脉损伤等严重并发症发生。出院后1、3、6、12个月,两组患者的Villalta评分比较,差异均无统计学意义(P>0.05)。出院后12个月,单纯抗凝组患者的下肢深静脉PTS发生率高于吸栓组患者,差异有统计学意义(P<0.05)。结论导管吸栓联合CDT是治疗早期IVCFT安全、有效的手段,有助于提高滤器回收成功率,降低下肢深静脉PTS的发生率。

Objective To investigate the efficacy and safety of catheter aspiration combined with catheter-directed thrombolysis(CDT)in the treatment of early inferior vena cava filter-associated thrombosis(IVCFT).Method The clinical data of 25 patients with early IVCFT found in the process of inferior vena cava filter retrieval and admitted to Hebei General Hospital from January 2019 to September 2021 were collected,patients were divided into two groups according to different treatment methods,15 patients treated with catheter aspiration combined with CDT were enrolled into the aspiration group,and 10 patients treated with anticoagulant therapy alone into the anticoagulation group.The filter retrieval,changes of hemoglobin before and after aspiration,dosage of urokinase,thrombolysis time and the occurrence of related complications[bleeding at the puncture site,pulmonary embolism(PE),major bleeding,major visceral hemorrhage,and inferior vena cava injury]were recorded in the two groups.The incidences of post-deep vein thrombosis syndrome(PTS)were compared at different time after discharge(1,3,6 and 12 months after discharge)in both groups were compared.Result Filters of 2 patients were retrieved after catheter aspiration in the aspiration group,and 13 patients underwent catheter aspiration combined with CDT,with the filter retrieval rate of 100%;the filter retrieval rate was 20% in anticoagulant group.The median thrombolysis time was 30(25,50)hours,median dosage of urokinase was 78(71,150)million units.In the aspiration group,there were 5 patients had bleeding at the puncture site,and no PE,major bleeding,major visceral hemorrhage,and inferior vena cava injury occurred in all patients.Villalta scores showed no significant difference between the two groups after 1,3,6 and 12 months of discharge(P>0.05).The incidence of PTS in the lower limb deep vein of patients in the anticoagulation group was higher than that in the aspiration group(P<0.05).Conclusion Aspiration combined with CDT is a safe and effective method in the treatment of early IVCFT,which can improve the success rate of filter retrieval and reduce the incidence of PTS in lower limb deep vein.