顺行与逆行入路治疗急性下肢深静脉血栓形成的单中心短期疗效比较

Single-centre short-term efficacy comparison of antegrade and retrograde approach for the treatment of acute lower limb deep vein thrombosis

目的对比顺行与逆行入路AngioJet血栓清除装置治疗急性下肢深静脉血栓形成(DVT)的疗效, 探讨置入下腔静脉滤器的必要性。方法回顾性分析2020年1月至2021年12月北京积水潭医院血管外科66例(69条肢体)使用AngioJet治疗的急性下肢DVT患者的临床资料。按照操作与瓣膜开放方向不同分为顺行治疗和逆行治疗两组, 评估两种治疗方法的滤器血栓拦截率、肺栓塞发生率、血栓清除效果、静脉阻塞率和血栓复发率。结果 66例患者中, 滤器血栓拦截率为37.9%(25/66), 新发肺栓塞或肺栓塞加重发生率为3.0%(2/66), 总体滤器取出率为95.5%(63/66)。顺行治疗组41例, 其中血栓Ⅲ级清除15例, Ⅱ级清除25例, Ⅰ级清除1例, 3个月静脉阻塞和血栓复发率为4.9%(2/41);逆行治疗组28例, 其中血栓Ⅲ级清除11例, Ⅱ级清除14例, Ⅰ级清除3例, 3个月静脉阻塞和血栓复发率为7.1%(2/28)。结论顺行与逆行入路治疗下肢DVT均安全有效, 短期深静脉通畅率良好, 逆行操作血栓清除亦可获得良好的疗效;急性下肢DVT使用AngioJet血栓清除治疗时血栓脱落风险较高, 建议放置腔静脉滤器进行有效拦截。

Objective To compare the efficacy of performing antegrade and retrograde approaches with the thrombectomy device,AngioJet,for the treatment of acute lower limb deep vein thrombosis(DVT)and explore the necessity of placement of filters.Methods Clinical data of 66 patients with acute lower limb DVT(69 limbs)treated with the AngioJet in the vascular surgery department of Beijing Ji-Shui-Tan Hospital from January 2020 to December 2021 were analyzed retrospectively.The patients were divided into two groups(antegrade treatment group and retrograde treatment group)according to the different operations and directions of valve opening.The thrombosis interception rate of the filter,incidence of pulmonary embolism(PE),effectiveness of thrombectomy,venous obstruction rate,and thrombosis recurrence rate of the two treatments were evaluated.Results The thrombosis interception rate of the filter was 37.9%(25/66),the incidence of new PE or PE exacerbation was 3.0%(2/66),and the overall filter retrieval rate was 95.5%(63/66).In the antegrade treatment group(n=41),thrombus removal of grade III occurred in 15 cases,grade II 25 cases,and grade I 1 case.Venous obstruction and thrombus recurrence rate 3 months after the surgery was 4.9%(2/41).In the retrograde treatment group(n=28),thrombus removal of grade III occurred in 11 cases,grade II 14 cases,and grade I 3cases.Venous obstruction and thrombosis recurrence rate 3 months after the surgery was 7.1%(2/28).Conclusion Both the antegrade and retrograde approaches are safe and effective in the treatment of lower limb DVT,with good short-term deep vein patency rates and good results with retrograde thrombectomy;acute lower limb DVT is at high risk of thrombus shedding when treated with AngioJet thrombectomy,and the placement of a vena cava filter is recommended for effective interception.