Straub Aspirex结合置管溶栓对比单纯置管溶栓治疗下肢深静脉血栓的研究
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摘要
目的回顾性分析Straub Aspirex机械性血栓清除术(PMT)结合置管溶栓术(CDT)对比单纯CDT治疗下肢深静脉血栓(LEDVT)的有效性、安全性。方法回顾性分析45例LEDVT患者的临床资料,其中CDT组30例,PMT+CDT组15例。分别记录两组在溶栓效果、溶栓时间、尿激酶(UK)剂量、24 h患肢消肿速率及并发症等方面的差异。P <0. 05为差异有统计学意义。结果 CDT组和PMT+CDT组的临床成功率无统计学差异[26例(86. 7%) vs. 14例(93. 3%),P=0. 502]。PMT+CDT较单纯CDT可显著缩短溶栓时间[(3. 1±1. 8)天vs.(7. 0±1. 3)天,P <0. 001)],减少UK剂量[(121. 7±94. 0)万U vs.(325. 0±107. 5)万U,P <0. 001]。PMT+CDT组和CDT组溶栓24 h后患侧大腿周径分别减少(2. 3±0. 7) cm和(1. 6±0. 6) cm;患侧小腿周径分别减少(1. 5±0. 6)cm和(1. 2±0. 5) cm,差异均具有统计学意义(P=0. 001,P=0. 026)。CDT组和PMT+CDT组的出血事件分别为5例(16. 7%)和2例(13. 3%)。随访期间,CDT组和PMT+CDT组分别有3例(10. 0%)和2例(13. 3%)患者发生血栓后综合征(PTS),差异无统计学意义(P=0. 737)。结论 Straub Aspirex结合CDT与单纯CDT治疗LEDVT具有相似的血栓清除效果和安全性。相较单纯CDT,Straub Aspirex结合CDT治疗具有缩短溶栓时间、减少UK剂量和快速缓解患肢肿胀的优势。
Objective To retrospectively review the efficacy and safety outcomes of percutaneous mechanical thrombectomy( PMT) using Straub Aspirex plus catheter-directed thrombolysis( CDT) versus CDT alone in the treatment of lower extremity deep vein thrombosis( LEDVT). Methods Clinical data of 45 consecutive patients with LEDVT treated with CDT alone( CDT group,n = 30) or PMT plus CDT( PMT + CDT group,n = 15) were reviewed. The differences including lytic grade,infusion time,total Urokinase( UK) dose,the relief of limb swelling after 24-hours of thrombolysis and complications between groups were noted. The modified Villalta scale was used to evaluate the morbidity and severity of postthrombotic syndrome( PTS). P < 0. 05 was considered statistically significant. Results There were no significant differences of clinical success between CDT group and PMT + CDT group( 26( 86. 7%) vs. 14( 93. 3%),P = 0. 498). Compared with CDT,PMT + CDT significantly reduced infusion time [( 3. 1 ± 1. 8) d vs.( 7. 0 ± 1. 3) d,P < 0. 001],dose of UK [( 121. 7 ± 94. 0) million units vs.( 325. 0 ± 107. 5) million units,P < 0. 001] and provided significant faster reduction of thigh and calf circumferences after 24-hour thrombolysis [thigh:( 2. 3 ± 0. 7) cm vs.( 1. 6 ± 0. 6) cm,P = 0. 001;calf:( 1. 5 ± 0. 6) cm vs.( 1. 2 ± 0. 5) cm,P = 0. 026]. Bleeding events were noted in 5( 16. 7%) patients and 2( 13.3%) patients in CDT group and PMT + CDT group,respectively. During the follow-up,3( 10. 0%) patients in CDT group and 2( 13. 3%) patients in PMT + CDT group developed PTS,respectively. There was no significant difference of PTS morbidity between the two groups( P = 0. 737). Conclusion Straub Aspirex plus CDT provided similar thrombolytic efficacy and safety outcomes compared with CDT alone. However,Straub Aspirex plus CDT showed superiorities in reducing infusion time,thrombolytic agent dose and provided faster symptom relief.
Objective To retrospectively review the efficacy and safety outcomes of percutaneous mechanical thrombectomy( PMT) using Straub Aspirex plus catheter-directed thrombolysis( CDT) versus CDT alone in the treatment of lower extremity deep vein thrombosis( LEDVT). Methods Clinical data of 45 consecutive patients with LEDVT treated with CDT alone( CDT group,n = 30) or PMT plus CDT( PMT + CDT group,n = 15) were reviewed. The differences including lytic grade,infusion time,total Urokinase( UK) dose,the relief of limb swelling after 24-hours of thrombolysis and complications between groups were noted. The modified Villalta scale was used to evaluate the morbidity and severity of postthrombotic syndrome( PTS). P < 0. 05 was considered statistically significant. Results There were no significant differences of clinical success between CDT group and PMT + CDT group( 26( 86. 7%) vs. 14( 93. 3%),P = 0. 498). Compared with CDT,PMT + CDT significantly reduced infusion time [( 3. 1 ± 1. 8) d vs.( 7. 0 ± 1. 3) d,P < 0. 001],dose of UK [( 121. 7 ± 94. 0) million units vs.( 325. 0 ± 107. 5) million units,P < 0. 001] and provided significant faster reduction of thigh and calf circumferences after 24-hour thrombolysis [thigh:( 2. 3 ± 0. 7) cm vs.( 1. 6 ± 0. 6) cm,P = 0. 001;calf:( 1. 5 ± 0. 6) cm vs.( 1. 2 ± 0. 5) cm,P = 0. 026]. Bleeding events were noted in 5( 16. 7%) patients and 2( 13.3%) patients in CDT group and PMT + CDT group,respectively. During the follow-up,3( 10. 0%) patients in CDT group and 2( 13. 3%) patients in PMT + CDT group developed PTS,respectively. There was no significant difference of PTS morbidity between the two groups( P = 0. 737). Conclusion Straub Aspirex plus CDT provided similar thrombolytic efficacy and safety outcomes compared with CDT alone. However,Straub Aspirex plus CDT showed superiorities in reducing infusion time,thrombolytic agent dose and provided faster symptom relief.
引文
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2 Heit JA,Spencer FA,White RH.The epidemiology of venous thromboembolism[J].J Thromb Thrombolysis,2016,41:3-14.
3 Mannucci PM,Poller L.Venous thrombosis and anticoagulant therapy[J].Br J Haematol,2001,114:258-270.
4 Baldwin MJ,Moore HM,Rudarakanchana N,et al.Post-thrombotic syndrome:a clinical review[J].J Thromb Haemost,2013,11:795-805.
5 Roberts LN,Patel RK,Donaldson N,et al.Post-thrombotic syndrome is an independent determinant of health-related quality of life following both first proximal and distal deep vein thrombosis[J].Haematologica,2014,99:e41-e43.
6 Haig Y,Enden T,Grotta O,et al.Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis(CaVenT):5-year follow-up results of an open-label,randomised controlled trial[J].Lancet Haematol,2016,3:e64-e71.
7郭连瑞,谷涌泉,佟铸,等.Aspirex机械旋吸导管微创治疗急性下肢深静脉血栓[J].国际外科学杂志,2015,42:831-834.
8赵俊来,赵克强,曹战江,等.机械血栓清除术治疗急性下肢静脉血栓形成的疗效分析[J].中华医学杂志,2015,95:3917-3919.
9 Lichtenberg M,Stahlhoff FW,Boese D.Endovascular treatment of acute limb ischemia and proximal deep vein thrombosis using rotational thrombectomy:A review of published literature[J].Cardiovasc Revasc Med,2013,14:343-348.
10 Mewissen MW,Seabrook GR,Meissner MH,et al.Catheter-directed thrombolysis for lower extremity deep venous thrombosis:report of a national multicenter registry[J].Radiology,1999,211:39-49.
11 Vedantham S,Grassi CJ,Ferral H,et al.Reporting standards for endovascular treatment of lower extremity deep vein thrombosis[J].JVasc Interv Radiol,2009,20:S391-S408.
12 Kearon C,Akl EA,Ornelas J,et al.Antithrombotic Therapy for VTEDisease:CHEST Guideline and Expert Panel Report[J].Chest,2016,149:315-352.
13 Kahn SR.Measurement properties of the Villalta scale to define and classify the severity of the post-thrombotic syndrome[J].J Thromb Haemost,2009,7:884-888.
14 Meissner MH,Gloviczki P,Comerota AJ,et al.Early thrombus removal strategies for acute deep venous thrombosis:clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum[J].J Vasc Surg,2012,55:1449-1462.
15 Plate G,Ekl9f B,Norgren L,et al.Venous thrombectomy for iliofemoral vein thrombosis-10-year results of a prospective randomised study[J].Eur J Vasc Endovasc Surg,1997,14:367-374.
16 Ruiz-Bailén M,Brea-Salvago JF,de Hoyos EA,et al.Post-thrombolysis intracerebral hemorrhage:data from the Spanish Register ARI-AM[J].Crit Care Med,2005,33:1829-1838.
17 Dumantepe M,Teymen B,Akturk U,et al.Efficacy of rotational thrombectomy on the mortality of patients with massive and submassive pulmonary embolism[J].J Card Surg,2015,30:324-332.
18 Dyer J,Rosa J,Chachlani M,et al.Aspirex Thrombectomy in Occluded Dialysis Access:A Retrospective Study[J].Cardiovasc Intervent Radiol,2016,39:1484-1490.
19 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[J].Cardiovasc Intervent Radiol,2006,29:1003-1007.
20陈国平,顾建平,何旭,等.低剂量尿激酶较长时间经导管直接溶栓术治疗急性髂-股静脉血栓形成的安全性和临床疗效[J].中华放射学杂志,2012,46:1119-1125.
21 Minko P,Bücker A,Laschke M,et al.Mechanical thrombectomy of iliac vein thrombosis in a pig model using the Rotarex and Aspirex catheters[J].Cardiovasc Intervent Radiol,2014,37:211-217.
22 Kim HS,Patra A,Paxton BE,et al.Adjunctive Percutaneous Mechanical Thrombectomy for Lower-extremity Deep Vein Thrombosis:Clinical and Economic Outcomes[J].J Vasc Interv Radiol,2006,17:1099-1104.
2 Heit JA,Spencer FA,White RH.The epidemiology of venous thromboembolism[J].J Thromb Thrombolysis,2016,41:3-14.
3 Mannucci PM,Poller L.Venous thrombosis and anticoagulant therapy[J].Br J Haematol,2001,114:258-270.
4 Baldwin MJ,Moore HM,Rudarakanchana N,et al.Post-thrombotic syndrome:a clinical review[J].J Thromb Haemost,2013,11:795-805.
5 Roberts LN,Patel RK,Donaldson N,et al.Post-thrombotic syndrome is an independent determinant of health-related quality of life following both first proximal and distal deep vein thrombosis[J].Haematologica,2014,99:e41-e43.
6 Haig Y,Enden T,Grotta O,et al.Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis(CaVenT):5-year follow-up results of an open-label,randomised controlled trial[J].Lancet Haematol,2016,3:e64-e71.
7郭连瑞,谷涌泉,佟铸,等.Aspirex机械旋吸导管微创治疗急性下肢深静脉血栓[J].国际外科学杂志,2015,42:831-834.
8赵俊来,赵克强,曹战江,等.机械血栓清除术治疗急性下肢静脉血栓形成的疗效分析[J].中华医学杂志,2015,95:3917-3919.
9 Lichtenberg M,Stahlhoff FW,Boese D.Endovascular treatment of acute limb ischemia and proximal deep vein thrombosis using rotational thrombectomy:A review of published literature[J].Cardiovasc Revasc Med,2013,14:343-348.
10 Mewissen MW,Seabrook GR,Meissner MH,et al.Catheter-directed thrombolysis for lower extremity deep venous thrombosis:report of a national multicenter registry[J].Radiology,1999,211:39-49.
11 Vedantham S,Grassi CJ,Ferral H,et al.Reporting standards for endovascular treatment of lower extremity deep vein thrombosis[J].JVasc Interv Radiol,2009,20:S391-S408.
12 Kearon C,Akl EA,Ornelas J,et al.Antithrombotic Therapy for VTEDisease:CHEST Guideline and Expert Panel Report[J].Chest,2016,149:315-352.
13 Kahn SR.Measurement properties of the Villalta scale to define and classify the severity of the post-thrombotic syndrome[J].J Thromb Haemost,2009,7:884-888.
14 Meissner MH,Gloviczki P,Comerota AJ,et al.Early thrombus removal strategies for acute deep venous thrombosis:clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum[J].J Vasc Surg,2012,55:1449-1462.
15 Plate G,Ekl9f B,Norgren L,et al.Venous thrombectomy for iliofemoral vein thrombosis-10-year results of a prospective randomised study[J].Eur J Vasc Endovasc Surg,1997,14:367-374.
16 Ruiz-Bailén M,Brea-Salvago JF,de Hoyos EA,et al.Post-thrombolysis intracerebral hemorrhage:data from the Spanish Register ARI-AM[J].Crit Care Med,2005,33:1829-1838.
17 Dumantepe M,Teymen B,Akturk U,et al.Efficacy of rotational thrombectomy on the mortality of patients with massive and submassive pulmonary embolism[J].J Card Surg,2015,30:324-332.
18 Dyer J,Rosa J,Chachlani M,et al.Aspirex Thrombectomy in Occluded Dialysis Access:A Retrospective Study[J].Cardiovasc Intervent Radiol,2016,39:1484-1490.
19 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[J].Cardiovasc Intervent Radiol,2006,29:1003-1007.
20陈国平,顾建平,何旭,等.低剂量尿激酶较长时间经导管直接溶栓术治疗急性髂-股静脉血栓形成的安全性和临床疗效[J].中华放射学杂志,2012,46:1119-1125.
21 Minko P,Bücker A,Laschke M,et al.Mechanical thrombectomy of iliac vein thrombosis in a pig model using the Rotarex and Aspirex catheters[J].Cardiovasc Intervent Radiol,2014,37:211-217.
22 Kim HS,Patra A,Paxton BE,et al.Adjunctive Percutaneous Mechanical Thrombectomy for Lower-extremity Deep Vein Thrombosis:Clinical and Economic Outcomes[J].J Vasc Interv Radiol,2006,17:1099-1104.