Acute extensive portal and mesenteric venous thrombosis after splenectomy:Treated by interventional thrombolysis with transjugular approach

AIM:To present a series of cases with symptomatic acute extensive portal vein(PV)and superior mesenteric vein(SMV)thrombosis after splenectomy treated by transjugular intrahepatic approach catheter-directed thrombolysis. METHODS:A total of 6 patients with acute extensive PV-SMV thrombosis after splenectomy were treated by transjugular approach catheter-directed thrombolysis. The mean age of the patients was 41.2 years.After access to the portal system via the transjugular approach,pigtail catheter fragmentation of clots, local urokinase injection,and manual aspiration thrombectomy were used for the initial treatment of PV-SMV thrombosis,followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV,which was performed for three to six days. Adequate anticoagulation was given during treatment, throughout hospitalization,and after discharge. RESULTS:Technical success was achieved in all 6 patients.Clinical improvement was seen in these patients within 12-24 h of the procedure.No complications were observed.The 6 patients were discharged 6-14 d(8±2.5 d)after admission.The mean duration of follow-up after hospital discharge was 40±16.5 mo.Ultrasound and contrast-enhanced computed tomography confirmed patency of the PV and SMV,and no recurrent episodes of PV-SMV thrombosis developed during the follow-up period. CONCLUSION:Catheter-directed thrombolysis via transjugular intrahepatic access is a safe and effective therapy for the management of patients with symptomatic acute extensive PV-SMV thrombosis.

Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt

A 66-year-old woman underwent partial splenic embolization （PSE） for hypersplenisrn with idiopathic portal hypertension （IPH）. One week later, contrast-enhanced CT revealed extensive portal vein thrombosis （PVT） and dilated portosystemic shunts. The PVT was not dissolved by the intravenous administration of urokinase. The right portal vein was canulated via the percutaneous transhepatic route under ultrasonic guidance and a 4 Fr. straight catheter was advanced into the portal vein through the thrombus. Transhepatic catheter-directed thrombolysis was performed to dissolve the PVT and a splenorenal shunt was concurrently occluded to increase portal blood flow, using balloon-occluded retrograde transvenous obliteration （BRTO） technique. Subsequent contrast-enhanced CT showed good patency of the portal vein and thrombosed splenorenal shunt. Transhepatic catheter-directed thrombolysis combined with BRTO is feasible and effective for PVT with portosystemic shunts.

Intra-arterial thrombolysis for early hepatic artery thrombosis after liver transplantation

BACKGROUND Early hepatic artery thrombosis(E-HAT)is a serious complication after liver transplantation(LT),which often results in graft failure and can lead to patient deaths.Treatments such as re-transplantation and re-anastomosis are conventional therapeutic methods which are restricted by the shortage of donors and the patient’s postoperative intolerance to re-laparotomy.Due to the advances in interventional techniques and thrombolytics,endovascular treatments are increasingly being selected by more and more centers.This study reviews and reports our single-center experience with intra-arterial thrombolysis as the first choice therapy for E-HAT after deceased donor LT.AIM To evaluate the feasibility and reasonability of intra-arterial thrombolysis for EHAT after deceased donor LT.METHODS A total of 147 patients who underwent deceased donor LT were retrospectively reviewed in our hospital between September 2011 and December 2016.Four patients were diagnosed with E-HAT.All of these patients underwent intraarterial thrombolysis with alteplase as the first choice therapy after LT.The method of arterial anastomosis and details of the diagnosis and treatment of EHAT were collated.The long-term prognosis of E-HAT patients was also recorded.The median follow-up period was 26 mo(range:23 to 30 mo).RESULTS The incidence of E-HAT was 2.7%(4/147).E-HAT was considered when Doppler ultrasonography showed no blood flow signals and a definite diagnosis was confirmed by immediate hepatic arterial angiography when complete occlusion of the hepatic artery was observed.The patients were given temporary thrombolytics(mainly alteplase)via a 5-Fr catheter which was placed in the proximal part of the thrombosed hepatic artery followed by continuous alteplase using an infusion pump.Alteplase dose was adjusted according to activated clotting time.The recanalization rate of intra-arterial thrombolysis in our study was 100%(4/4)and no thrombolysis-related mortality was observed.During the follow-up period,patient survival rate was 75%(3/4),and biliary complications were present in 50%of patients(2/4).CONCLUSION Intra-arterial thrombolysis can be considered first-line treatment for E-HAT after deceased donor LT.Early diagnosis of E-HAT is important and follow-up is necessary even if recanalization is successful.

Successful treatment of acute symptomatic extensive portal venous system thrombosis by 7-day systemic thrombolysis

Acute portal venous system thrombosis(PVST)can cause acute mesenteric ischemia and even intestinal infarction,which are potentially fatal,and requires recanalization in a timely fashion.Herein,we report a 56-year-old man with acute non-cirrhotic symptomatic extensive PVST who achieved portal vein recanalization after systemic thrombolysis combined with anticoagulation.Initially,anticoagulation with enoxaparin sodium for 4 d was ineffective,and then systemic thrombolysis for 7 d was added.After that,his abdominal pain completely disappeared,and portal vein system vessels became gradually patent.Long-term anticoagulation therapy was maintained.In conclusion,7-d systemic thrombolysis may be an effective and safe choice of treatment for acute symptomatic extensive PVST which does not respond to anticoagulation therapy.

Clinical outcomes of Angio Jet pharmacomechanical thrombectomy versus catheter-directed thrombolysis for the treatment of filter-related caval thrombosis

BACKGROUND The inferior vena cava filter is utilized worldwide to intercept thrombi and to reduce the risk of fatal pulmonary embolism(PE).However,filter-related thrombosis is a complication of filter implantation.Endovascular methods such as AngioJet rheolytic thrombectomy(ART)and catheter-directed thrombolysis(CDT)can treat filter-related caval thrombosis,but the clinical outcomes of both treatment modalities have not been determined.AIM To compare the treatment outcomes of AngioJet rheolytic thrombectomy vs catheter-directed thrombolysis in patients with filter-related caval thrombosis.METHODS In this single-center retrospective study,65 patients(34 males and 31 females;mean age:59.0±13.43 years)with intrafilter and inferior vena cava thrombosis were enrolled between January 2021 and August 2022.These patients were assigned to either the AngioJet group(n=44)or the CDT group(n=21).Clinical data and imaging information were collected.Evaluation measures included thrombus clearance rate,periprocedural complications,urokinase dosage,incidence of PE,limb circumference difference,length of stay,and filter removal rate.RESULTS Technical success rates were 100%in the AngioJet and CDT groups.In the AngioJet group,grade II and grade III thrombus clearance was achieved in 26(59.09%)and 14(31.82%)patients,respectively.In the CDT group,grade II and grade III thrombus clearance was accomplished in 11(52.38%)patients and 8(38.10%)patients,respectively(P>0.05).The peridiameter difference of the thigh was significantly reduced in patients from both groups after treatment(P<0.05).The median dosage of urokinase was 0.08(0.02,0.25)million U in the AngioJet group and 1.50(1.17,1.83)million U in the CDT group(P<0.05).Minor bleeding was shown in 4(19.05%)patients in the CDT group,and when it was compared with that in the AngioJet group,the difference was statistically significant(P<0.05).No major bleeding occurred.Seven(15.91%)patients in the AngioJet group had hemoglobinuria and 1(4.76%)patient in the CDT group had bacteremia.There were 8(18.18%)patients with PE in the AngioJet group and 4(19.05%)patients in the CDT group before the intervention(P>0.05).Computed tomography angiopulmonography(CTA)showed that PE was resolved after the intervention.New PE occurred in 4(9.09%)patients in the AngioJet group and in 2(9.52%)patients in the CDT group after theintervention(P>0.05).These cases of PE were asymptomatic.The mean length of stay was longer in the CDT group(11.67±5.34 d)than in the AngioJet group(10.64±3.52 d)(P<0.05).The filter was successfully retrieved in the first phase in 10(47.62%)patients in the CDT group and in 15(34.09%)patients in the AngioJet group(P>0.05).Cumulative removal was accomplished in 17(80.95%)out of 21 patients in the CDT group and in 42(95.45%)out of 44 patients in the ART group(P>0.05).The median indwelling time for patients with successful retrieval was 16(13139)d in the CDT group and 59(12231)d in the ART group(P>0.05).CONCLUSION Compared with catheter-directed thrombolysis,AngioJet rheolytic thrombectomy can achieve similar thrombus clearance effects,improve the filter retrieval rate,reduce the urokinase dosage and lower the risk of bleeding events in patients with filter-related caval thrombosis.

Agitation thrombolysis combined with catheter-directed thrombolysis for the treatment of non-cirrhotic acute portal vein thrombosis

AIM To evaluate the safety and efficacy of agitation thrombolysis(AT) combined with catheter-directed thrombolysis(CDT) for the treatment of non-cirrhotic acute portal vein thrombosis(PVT). METHODS Nine patients with non-cirrhotic acute PVT who underwent AT combined with CDT were analyzed retrospectively. Portography was carried out via the transjugular intrahepatic portosystemic(commonly known as TIP) or percutaneous transhepatic(commonly known as PT) route, followed by AT combined with CDT. Complications of the procedure, and the changes in clinical symptoms, hemodynamics of the portal vein and liver function were recorded. Follow-up was scheduled at1, 3 and 6 mo after treatment, and every 6 mo thereafter, or when the patients developed clinical symptoms related to PVT. Color Doppler ultrasound and contrast-enhanced computed tomography/magnetic resonance imaging were performed during the follow-up period to determine the condition of the portal vein.RESULTS AT combined with CDT was successfully performed. The portal vein was reached via the TIP route in 6 patients, and via the PT route in 3 patients. All clinical symptoms were relieved or disappeared, with the exception of 1 patient who died of intestinal necrosis 9 d after treatment. Significant differences in the changes in portal vein hemodynamics were observed, including the maximum lumen occupancy of PVT, portal vein pressure and flow velocity between pre-and posttreatment(P < 0.05). During the follow-up period, recurrence was observed in 1 patient at 19 mo after the procedure, and the portal vein was patent in the remaining patients.CONCLUSION AT combined with CDT is a safe and effective method for the treatment of non-cirrhotic acute PVT.

Initial transcatheter thrombolysis for acute superior mesenteric venous thrombosis

AIM: To determine the optimal initial treatment modality for acute superior mesenteric vein thrombosis (ASMVT) in patients with circumscribed peritonitis.

Efficacy of percutaneous mechanical thrombus removal in acute lower extremity deep venous thrombosis

BACKGROUND Acute lower extremity deep venous thrombosis(LEDVT)is a common vascular emergency with significant morbidity risks,including post-thrombotic syndrome(PTS)and pulmonary embolism.Traditional treatments like catheter-directed thrombolysis(CDT)often result in variable success rates and complications.AIM To investigate the therapeutic efficacy of percutaneous mechanical thrombus removal in acute LEDVT.METHODS A retrospective analysis was performed to examine 58 hospitalised patients with acute LEDVT between August 2019 and August 2022.The patients were categorised into the percutaneous mechanical thrombectomy(PMT)group(n=24)and CDT group(n=32).The follow-up,safety and treatment outcomes were compared between the two groups.The main observational indexes were venous patency score,thrombus removal effect,complications,hospitalisation duration and PTS.RESULTS The venous patency score was 9.04±1.40 in the PMT group and 8.81±1.60 in the CDT group,and the thrombus clearance rate was 100%in both groups.The complication rate was 8.33%in the PMT group and 34.84%in the CDT group,and the difference was statistically significant(P<0.05).The average hospitalisation duration was 6.54±2.48 days in the PMT group and 8.14±3.56 days in the CDT group.The incidence of PTS was lower in the PMT group than in the CDT group;however,the difference was not statistically significant(P<0.05).CONCLUSION Compared with CDT,treatment of LEDVT via PMT was associated with a better thrombus clearance rate,clinical therapeutic effect and PTS prevention function,but the difference was not statistically significant.Moreover,PMT was associated with a reduced urokinase dosage,shortened hospitalisation duration and reduced incidence of complications,such as infections and small haemorrhages.These results indicate that PMT has substantial beneficial effects in the treatment of LEDVT.

Safety and Efficacy of Low Dosage of Urokinase for Catheter-directed Thrombolysis of Deep Venous Thrombosis

Background： Catheter-directed thrombolysis （CDT） has been a mainstay in treating deep venous thrombosis （DVT）. However, the optimal dosage ofa thrombolytic agent is still controversial. The goal of this study was to evaluate the safety and efficacy of low dosage urokinase with CDT for DVT. Methods： A retrospective analysis was perfornaed using data from a total of 427 patients with DVT treated with CDT in our single center between July 2009 and December 2012. Early efficacy of thrombolysis was assessed with a thrombus score based on daily venography. The therapeutic safety was evahmted by adverse events. A venography or duplex ultrasound was performed to assess the outcome at 6 months, 1 year and 2 years postoperatively. Results： The mean total dose of 3.34 （standard deviation [SD] 1.38） million units of urokinase was administered during a mean of 5.18 （SD 2.28） days. Prior to discharge, Grade Ⅲ （complete lysis） was achieved in 154 （36%） patients; Grade II （50-99% lysis） in 222 （52%）： and Grade I （50%~ lysis） in 51 （12%）. The major complications included one intracranial hemorrhage, one henaatochezia, five gross hematuria, and one pulmonary embolism. Moreover, no death occurred in the study. Conclusions： Treatment of low-dose catheter-directed thrombosis is an efficacious and safe therapeutic approach in patients with DVT offering good long-term outcomes and minimal complications.

Stenting of iliac vein obstruction following catheter-directed thrombolysis in lower extremity deep vein thrombosis

Background Catheter-directed thrombolysis （CDT） for deep venous thrombosis （DV-F） of the lower extremity has good effect, but whether iliac vein stent placement after thrombolytic therapy is still controversial. The goal of this study was to evaluate the efficacy of stent placement in the iliac vein following CDT in lower extremity DVT. Methods This was a single-canter, prospective, randomized controlled clinical trial. After receiving CDT, the major branch of the distal iliac vein was completely patent in 155 patients with lower extremity DVT, and 74 of these patients with iliac vein residual stenosis of 〉50% were randomly divided into a control group （n=29） and a test group （n=45）. In the test group, stents were implanted in the iliac vein, whereas no stents were implanted in the control group. We evaluated the clinical indicators, including patency of the deep vein, C in CEAP classification, Venous Clinical Severity Score （VCSS）, and Chronic Venous Insufficiency Questionnaire （CIVIQ） Score. Results All patients had postoperative follow-up visits for a period of 6-24 months. Venography or color ultrasound was conducted in subjects. There was a significant difference between the patency rate at the last follow-up visit （87.5% vs. 29.6%） and the 1-year patency rate （86.0% vs. 54.8%） between the test and control groups. The change in the C in CEAP classification pre- and post-procedure was significantly different between the test and control groups （1.61±0.21 vs. 0.69±0.23）. In addition, at the last follow-up visit, VCSS and CIVIQ Score were both significantly different between the test and control groups （7.57±0.27 vs. 0.69±0.23; 22.67±3.01 vs. 39.34±6.66, respectively）. Conclusion The stenting of iliac vein obstruction following CDT in lower extremity DVT may increase the patency of the deep vein, and thus provides better efficacy and quality of life.

下肢深静脉血栓治疗的分析与展望

近年来,新技术的进步并未带来下肢深静脉血栓(DVT)疗效的改善,血栓后综合征(PTS)发病率仍较高。各项大型临床研究结果显示,下肢DVT的介入治疗或外科治疗较单纯抗凝治疗无明显优势,国内外相关专业学会发布的指南也有不同意见,给下肢DVT临床治疗决策带来困扰。从血栓病理过程分析,静脉血栓造成炎症反应,损伤静脉壁及瓣膜,血栓逐渐机化使各种疗法效果趋于下降,早期快速血栓清除可中止静脉损伤,减少血栓残余,有效降低PTS发生率。因此,参考患者病程的个体化治疗有望取得更满意的疗效。

超声引导下腘静脉穿刺置管介入溶栓治疗对下肢深静脉血栓形成的疗效分析

目的:分析超声引导下腘静脉穿刺置管介入溶栓治疗对下肢深静脉血栓形成(DVT)的疗效。方法:选取2021年1月—2022年6月重庆医科大学附属第一医院收治的60例下肢DVT患者为研究对象。依据患者的治疗方式不同分为研究组(30例,超声引导下腘静脉穿刺置管介入溶栓治疗)和对照组(30例,常规口服药物治疗),研究组患者采用超声引导下腘静脉穿刺置管介入溶栓治疗,对照组患者单纯采用口服抗凝药物治疗。比较两组患者治疗前后,半年内下肢静脉血栓的再通率、再通疗效及远期血栓后综合征发生率。结果:研究组半年内下肢静脉再通率高于对照组(P <0.05);研究组下肢静脉血栓半年内再通疗效评分高于对照组(P <0.05);研究组下肢静脉血栓形成后综合征的发生率低于对照组(P <0.05)。结论:超声引导下腘静脉穿刺置管介入溶栓治疗下肢深静脉血栓能够获得更好的静脉再通率及总体疗效,并改善远期血栓后综合征发生率,具有非常重要的应用价值。

TIPS联合置管溶栓(或联合局部处理)治疗门静脉血栓临床疗效

目的探讨经颈静脉肝内门体静脉分流术(TIPS)联合置管溶栓的临床疗效。方法回顾性分析我院2016年1月至2019年12月收治的307例门静脉高压症合并门静脉血栓(PVT)患者成功行TIPS联合留置导管溶栓的临床疗效。通过术中测量分流前后下腔静脉压力(inferior vena cava pressure,ICVP)、分流前后门静脉压力(portal vein pressure,PVP),分别计算分流前、分流后(溶栓前)及溶栓后门静脉压力梯度(portal pressure gradient,PPG)(PPG=PVP-IVCP),通过再次DSA下行门静脉造影观察PVT消失程度及分流道是否通畅。所有患者均按时随访1年。结果分流前、分流后(溶栓前)及溶栓后平均PPG分别为(24.50±6.91)mmHg、(18.51±5.11)mmHg及(10.17±3.97)mmHg,溶栓后PPG明显低于溶栓前PPG,具有显著的统计学意义(P<0.001);307例患者中,PVT完全消失者占72.3%(221/307)、显著减少者占27.7%(86/307)、无无效病例;分流道血流完全通畅者占85.7%(261/307),部分通畅者占14.3%(46/307);发生合并症42例,无死亡病例。全部患者均随访1年。临床症状改善情况:所有患者主要临床症状均有所改善或完全消失。其中17例患者(5.5%)血栓较术后增加,经TIPS分流道对血栓进行局部处理联合置管溶栓,全部患者分流道恢复至第一次术后水平。肝性脑病发生情况:术后1年内发生显性肝性脑病(OHE)17.6%(54/307)。生存情况:术后9个月及11个月因肝功能衰竭及脑出血分别死亡1例,其他患者全部生存。结论门静脉高压症合并PVT患者行TIPS联合置管溶栓效果良好,安全。应加强全流程系统化管理。

Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-sub-acute portal vein and superior mesenteric vein throm-bosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were ac-curately diagnosed with Doppler ultrasound scans, com-puted tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutane-ous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization). RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased signif icantly. Symptoms in these 45 patients were improved dramatically without severe operationalcomplications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi reformed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful. CONCLUSION: Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.

股静脉及胫前静脉入路导管接触溶栓治疗急性下肢深静脉血栓形成患者近期效果和安全性观察

目的评价股静脉入路及胫前静脉入路导管接触溶栓(CDT)治疗急性下肢深静脉血栓形成(LEDVT)患者近期效果和安全性。方法回顾性对照分析2019年1月至2021年12月在南京医科大学第二附属医院接受健侧股静脉人路及患侧胫前静脉入路CDT治疗的LEDVT患者临床资料。其中股静脉人路组40例,胫前静脉入路组46例。主要观察终点为手术技术成功率和血栓清除率,次要观察终点为手术时间和并发症。结果股静脉人路组、胫前静脉人路组手术技术成功率分别为92.5%、100%(P=0.097),血栓清除率分别为(68.9±25.9)%、(78.3±21.0)%(P=0.067),差异均无统计学意义;手术时间分别为(64.1±14.8)min、(72.0±19.9)min(P=0.037),差异有统计学意义;并发症发生率分别为22.5%、10.9%(P=0.145),差异无统计学意义。结论股静脉人路和胫前静脉人路CDT均可有效治疗LEDVT,近期疗效和安全性相当。

A hybrid technique： intra-arterial catheter-directed thrombolysis following the recanalization of superior mesenteric artery in acute mesenteric ischemia

Acute mesenteric ischemia is a deadly process withoverall mortality rate of 40%. Acute thrombosis of an atherosclerotic lesion with previous partial occlusion isone of the common causes. Peri-operative mortality ofsuperior mesenteric artery （SMA） thrombosis is higherbecause of the difficulty in diagnosis,

Pulse-spray catheter directed thrombolysis in patients with recent onset or deterioration of lower extremity ischemia

Background The recent onset or deterioration of lower extremity ischemia is highly associated with intravascular thrombus.Treatment of these thrombotic occlusions is challenging.Pulse-spray catheter directed thrombolysis （PS-CDT） refers to the technique of intermittent forcefully injecting the thrombolytic agent into the thrombus to fragment it and increase the surface area available for enzymatic action.This study was designed to evaluate the efficacy and safety of PS-CDT in patients with recent onset or deterioration of lower extremity ischemia.Methods From August 2008 to March 2009,44 patients with acute or chronic lower extremity ischemia were recruited in this prospective study,which included 37 men and 7 women ranging from 15 to 83 years old （mean age （51.1±17.4） years）.PS-CDT through a multi-side-hole thrombolytic catheter by using urokinase was conducted in all patients.The progression of thrombolysis was assessed and graded by angiography.Adjunctive therapies were used to correct underlying lesions.The follow-up period was 12 months.Results In the 44 patients,the average total dose of urokinase for each patient was （2120000±1100000） IU （median 2000000 IU）,with a median duration of lysis of 48 hours.The rate of initial technical success was 97.7%.The rate of clinically successful lysis was 81.8%.Early （〈30 days） and late （from 30 days to 12 months） amputation rates were both 4.5% （2/44）.The overall amputation rate was 9.1% （4/44）.No mortality was recorded during thrombolysis and follow-up period （12 months）.No major bleeding or allergic reaction was seen during thrombolytic therapy.11.4% had symptoms of distal embolization.The primary patency rate for the arteries that were clinically successfully thrombolyzed as compared with those that failed to lysis was 83.3% vs.57.1%,respectively,at 1 year.Conclusions PS-CDT,combined with adjunctive therapies,is associated with good safety and efficacy in recent-onset or deterioration of lower extremity ischemia.Successful thrombolysis may be accompanied by better outcomes.

重组人尿激酶原置管溶栓治疗急性下肢深静脉血栓对患者血流动力学水平和下肢静脉功能的影响

目的观察重组人尿激酶原(rhPro-UK)置管溶栓治疗急性下肢深静脉血栓(DVT)对患者血流动力学水平和下肢静脉功能的影响。方法前瞻性选取2019年9月至2023年5月天津市第四中心医院收治的DVT患者100例,采用随机数字表法分为观察组与对照组,每组各50例。两组均给予低分子肝素钠注射液进行抗凝治疗,对照组给予尿激酶置管溶栓治疗,观察组给予rhPro-UK置管溶栓治疗。检测两组治疗前和治疗5 d后的血流动力学(静脉容积、静脉最大流出量及静脉压恢复时间)、血液流变学指标[全血低、中、高切黏度及血浆黏度、纤维蛋白原(FIB)、D-二聚体]变化,评估两组治疗前和治疗5 d后的深静脉通畅评分,计算两组深静脉通畅率,测定两组患肢与健侧不同部位周径差,对比两组并发症发生率。结果治疗5 d后,两组静脉容积、静脉最大流出量、静脉回流速率及静脉压恢复时间均较治疗前升高,观察组静脉容积、静脉压恢复时间分别为(7.58±1.33)mL、(12.87±2.61)s,均高于对照组[(7.01±1.24)mL、(11.14±2.87)s],差异均有统计学意义(P<0.05),两组静脉最大流出量、静脉回流速率比较,差异均无统计学意义(P>0.05)。治疗5 d后,两组全血黏度(涵盖低、中、高切)、血浆黏度、FIB、D-二聚体均较治疗前降低,观察组FIB、D-二聚体分别为(2.71±0.85)g/L、(1.32±0.36)mg/L,均低于对照组[(3.22±1.02)g/L、(1.74±0.41)mg/L],差异均有统计学意义(P<0.05)。两组全血低、中、高切黏度、血浆黏度与对照组比较,差异均无统计学意义(P>0.05);治疗5 d后,两组深静脉通畅评分均较治疗前降低,观察组为(1.47±0.43)分,低于对照组[(2.19±0.67)分],观察组深静脉通畅率为(83.32±7.69)%,高于对照组[(75.85±8.41)%],差异均有统计学意义(P<0.05)。治疗5 d后,两组患肢与健侧股部、膝上15 cm、膝下15 cm周径差均较治疗前降低,观察组治疗后患肢与健侧股部、膝上15 cm周径差分别为(1.06±0.61)、(1.04±0.51)cm,均低于对照组[(1.48±0.89)、(1.32±0.68)cm],差异均有统计学意义(P<0.05);两组膝下15 cm周径差比较,差异无统计学意义(P>0.05)。观察组与对照组的总并发症发生率比较,差异无统计学意义(P>0.05)。结论rhPro-UK置管溶栓治疗急性DVT可改善患者血流动力学和血液流变学,促进患肢消肿,增加深静脉通畅率,有助于保护静脉功能。

机械性血栓清除术与置管溶栓治疗急性下肢深静脉血栓的短中期疗效对比

目的 探讨机械性血栓清除术(PMT)与置管溶栓术(CDT)治疗急性下肢深静脉血栓(LEDVT)的短中期疗效。方法 收集2019年4月至2021年4月于合肥市第二人民医院就诊的85例急性LEDVT患者的临床资料,按照治疗方法的不同将其分为PMT组(n=37)和CDT组(n=48)。比较两组患者大腿周径差、小腿周径差、尿激酶使用量、溶栓时间,术后出血、血红蛋白尿及血栓形成后综合征(PTS)发生情况。结果 两组患者大腿周径差、小腿周径差比较,差异均无统计学意义(P>0.05)。PMT组患者溶栓时间明显短于CDT组患者,尿激酶使量明显小于CDT组患者,差异均有统计学意义(P<0.01)。两组患者血红蛋白尿、出血/皮下血肿发生率比较,差异均有统计意义(P<0.05)。PMT组患者血栓完全清除率、血栓大部分清除率均高于CDT组患者,差异均有统计学意义(P<0.05)。术后6个月,两组患者PTS程度比较,差异均无统计学意义(P>0.05)。术后12个月,PMT组患者无PTS、轻度PTS比例均小于CDT组患者,差异均有统计学意义(P<0.05)。结论 PMT与CDT血栓清除率相似,PMT在避免短中期发生PTS方面更有优势,PMT溶栓时间短,溶栓药物使用剂量小,缩短了患者的住院时间。

rt-PA静脉溶栓对AIS患者机械取栓后血栓面积及病理成分的影响

目的探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓对急性缺血性脑卒中(AIS)患者机械取栓后血栓面积及病理成分的影响。方法选取2022年1-12月该院卒中中心进行机械取栓手术的120例AIS患者作为研究对象,根据治疗方式分为桥接治疗组(62例)和单纯机械取栓组(58例),桥接治疗组接受rt-PA静脉溶栓+机械取栓治疗,单纯机械取栓组仅接受机械取栓治疗。收集两组患者的一般资料,比较两组美国国立卫生研究院卒中量表(NIHSS)评分及改良Rankin量表(mRS)评分,并对所有机械取栓收集的血栓标本进行处理,分析两组患者血栓特征。结果两组基线资料比较,差异均无统计学意义(P>0.05)。两组治疗前NIHSS与mRS评分比较,差异均无统计学意义(P>0.05);治疗后,两组NIHSS、mRS评分均较治疗前降低,差异均有统计学意义(P<0.05),但两组间比较,差异均无统计学意义(P>0.05)。两组术后血管成功再通率及90 d预后良好率比较,差异均无统计学意义(P>0.05)。两组血栓中的红细胞占比、纤维蛋白/血小板占比、白细胞占比比较,差异均无统计学意义(P>0.05),但桥接治疗组的血栓总面积、红细胞面积、纤维蛋白/血小板面积、白细胞面积明显小于单纯机械取栓组,差异均有统计学意义(P<0.05)。结论rt-PA静脉溶栓可明显减少AIS患者机械取栓后的血栓面积,同时对血栓主要病理成分的面积也有缩减作用,但对血栓主要病理成分的占比不构成影响。