中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

药物机械碎栓和导管接触性溶栓对于下肢深静脉血栓患者的股静脉瓣膜功能影响的比较分析

查看全文

目的 比较分析药物机械碎栓和导管接触性溶栓对于下肢深静脉血栓患者的股静脉瓣膜功能的影响。 方法 回顾性分析 2016 年 10 月到 2017 年 3 月我科室收治的 60 例急性髂股静脉血栓形成的患者的临床资料。将患者分成三组,A 组 36 例患者(男 20 例、女 16 例,平均年龄 56 岁)仅行 CDT(catheter-directed thrombolysis)治疗,B 组 15 例患者(平均年龄 55 岁,男 8 例、女 7 例)行单纯 PMT(pharmacomechanical thrombectomy)治疗,C 组 9 例患者(平均年龄 56 岁,男 4 例、女 5 例)行 PMT 联合 CDT 治疗。比较三组治疗前后股静脉瓣膜功能情况。 结果 在出院时有 40.0%(24/60)的患者存在双侧下肢深静脉瓣膜的反流。有 40.0%(24/60)的患者存在单侧深静脉瓣膜反流(均为患肢)。有 20.0%(12/60)的患者没有瓣膜反流。单纯 CDT 治疗组中有 38.9%(14/36)的患者术后存在患肢股静脉瓣膜反流,单纯 PMT 治疗组中有 33.3%(5/15)的患者术后存在患肢股静脉瓣膜反流,PMT 联合 CDT 组中有 55.6%(5/9)的患者术后存在患肢股静脉瓣膜反流(P=0.077),差异无统计学意义。 结论 PMT 相比于 CDT 并不增加对于深静脉瓣膜功能的损害

Objective To Compare vein valve function following pharmacomechanical thrombolysis (PMT) with simple catheter-directed thrombolysis for deep vein thrombosis. Methods We retrospectively analyzed the clinical data of sixty patients who suffered acute lower extremity deep vein thrombsis in our hospital between October 2016 and March 2017. All patients underwent contralateral preprocedural duplex and bilateral postprocedure duplex to access patency and valve function. The patients were divided into three groups including a group A with catheter-directed thrombolysis (CDT) alone (36 patients with 20 males and 16 females at average age of 56 years), a group B with PMT alone (15 patients with 5 males and 4 females at average age of 56 years), and a group C with PMT combined CDT (9 patients with 5 males and 4 females at average age of 56 years). The valve function was compared among the Group A, Group B and Group C. Results There were 40.0% (24/60) patients had bilateral femoral vein valve reflux, 40.0% (24/60) patients had unilateral femoral vein valve reflux (all in the treated limbs), 20% (12/60) patients had no reflux in both limbs. Of the limbs treated with CDT alone, PMT alone and PMT combined CDT demonstrated valve reflux 38.9% (14/36), 33.3% (5/15) and 55.6% (5/9) respectively (P=0.077). Conclusions In patients suffering acute DVT, PMT or PMT combined CDT doesn’t hamper valve function compared with CDT alone.

关键词: 下肢深静脉血栓; 药物机械碎栓; 导管接触性溶栓; 静脉瓣膜功能

Key words: Deep vein thrombosis; pharmacomechanical thrombolysis; Catheter-directed thrombolysis; femoral vein valve function

登录后 ,请手动点击刷新查看全文内容。 没有账号,
1. Roddy SP. Quantity of clot lysed after catheter-directed thrombolysis for iliofemoral deep vein thrombosis correlates with postthrombotic morbidity. J Vasc Surg, 2010, 51(5): 1318-1319.
2. Dasari TW, Pappy R, Hennebry TA. Pharmacomechanical thrombolysis of acute and chronic symptomatic deep vein thrombosis: a systematic review of literature. Angiology, 2012, 63(2): 138-145.
3. Malgor RD, Gasparis AP. Pharmaco-mechanical thrombectomy for early thrombus removal. Phlebology, 2012, 27(Suppl 1): 155-162.
4. Robertson L, McBride O, Burdess A. Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis. Cochrane Database Syst Rev, 2016, 11: CD011536.
5. Garcia MJ, Lookstein R, Malhotra R, et al. Endovascular Management of Deep Vein Thrombosis with Rheolytic Thrombectomy: Final Report of the Prospective Multicenter PEARL (Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths) Registry. J Vasc Interv Radiol, 2015, 26(6): 777-785.
6. Vedantham S, Goldhaber SZ, Kahn SR, et al. Rationale and design of the ATTRACT Study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J, 2013, 165(4): 523-530.
7. Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg, 2011, 53(5 Suppl): 2S-48S.
8. 仇鹏, 司小毛, 查斌山, 等. 溶栓联合抗凝与单纯抗凝治疗下肢深静脉血栓疗效及安全性Meta分析. 中华普通外科杂志, 2014, 29(6): 467-470.
9. Huang CY, Hsu HL, Kuo TT, et al. Percutaneous pharmacomechanical thrombectomy offers lower risk of post-thrombotic syndrome than catheter-directed thrombolysis in patients with acute deep vein thrombosis of the lower limb. Ann Vasc Surg, 2015, 29(5): 995-1002.
10. Kuo TT, Huang CY, Hsu CP, et al. Catheter-directed thrombolysis and pharmacomechanical thrombectomy improve midterm outcome in acute iliofemoral deep vein thrombosis. J Chin Med Assoc, 2017, 80(2): 72-79.
11. Stanley GA, Murphy EH, Plummer MM, et al. Midterm results of percutaneous endovascular treatment for acute and chronic deep venous thrombosis. J Vasc Surg Venous Lymphat Disord, 2013, 1(1): 52-58.
12. Lin PH, Zhou W, Dardik A, et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg, 2006, 192(6): 782-788.
13. 段鹏飞, 倪才方, 刘凯, 等. 药物-机械偶联式血栓清除术治疗急性下肢深静脉血栓形成. 中华普通外科杂志, 2016, 31(4): 338-339.
14. Casanegra AI, McBane RD, Bjarnason H. Intervention radiology for venous thrombosis: early thrombus removal using invasive methods. Br J Haematol, 2017, 177(2): 173-184.
15. van Haarst EP, Liasis N, van Ramshorst B, et al. The development of valvular incompetence after deep vein thrombosis: a 7 year follow-up study with duplex scanning. Eur J Vasc Endovasc Surg, 1996, 12(3): 295-299.
16. Du GC, Zhang MC, Zhao JC. Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis. Vasa, 2015, 44(3): 195-202.
17. Kim HS, Patra A, Paxton BE, et al. Catheter-directed thrombolysis with percutaneous rheolytic thrombectomy versus thrombolysis alone in upper and lower extremity deep vein thrombosis. Cardiovasc Intervent Radiol, 2006, 29(6): 1003-1007.
18. Pianta MJ, Thomson KR. Catheter-directed thrombolysis of lower limb thrombosis. Cardiovasc Intervent Radiol, 2011, 34(1): 25-36.