Clinical Analysis Of The Treatment Of Acute Lower Extremity Deep Venous Thrombosis By Using Catheter-directed Thrombolysis And Inferior Vena Cava Filter Placement

Objective:To evaluate the clinical efficacy and safety of the catheter directed thrombolysis (CDT) combined with inferior vena cava filter (IVCF) placement for acute lower extremity deep vein thrombosis (DVT).Method:The clinical data of43patients with acute iliofemoral deep venous thrombosis from October2012to October2013in the QianFoShan Hospital Affiliated to ShanDong University were analyzed retrospectively. Patients of group CDT were25cases, treated with anticoagulation, catheter-directed thrombolysis and inferior vena cava filter placement.18cases of group TT received the traditional dorsal venous thrombolysis and anticoagulation. The efficacy were evaluated by the circumference difference between normal and affected limbs, score of venous patency, and the improvement rate of venous patency and the rate of Post-thrombosis Syndrome (PTS). The safety of treatment was judged according to the incidence of pulmonary embolism, bleeding and other related complications. The total dose of urokinase and the length of hospital stay were compared in the two groups. All data was treated with SPSS17.0statistical package.Results:All patients in the limb swelling and pain degrees reduced to some extent after the treatment. The differences in circumference between impaired thigh and healthy thigh and between impaired leg and healthy leg after treatment were (4.40±1.23)cm and (4.62±1.19)cm in the group CDT,which were (3.47±1.02)cm and (3.67±1.27)cm in the group TT. The circumference difference of leg or upper leg before and after treatment in the CDT group was significantly greater than that in the TT group(P<0.05). Venous patency degree of CDT group before and after treatment respectively were (11.88±2.52) point,(3.72±1.14) point, which were (11.39±2.30) point,(4.67±1.28) point in the group TT. The mean rate of patency improvement in group CDT after treatment was (68.43±7.88)%, which was significantly better than that in the group TT (59.34±6.73)%(P<0.05)).The total dose of urokinase (369.60±81.42) x104and the resolution time of hospital stays (12.28±4.23) dof Group CDT was less than those of group TT (451.67±95.19)×104U and(16.39±6.55) d, which has significant difference(P<0.05).The complications of the group CDT included fever (2cases), bleeding at the puncture site (1case), A small amount of subcutaneous ecchymosis at the puncture site (1case).The gums bleed in2cases and vaginal bleeding in1cases were observed in the group TT. Major complications of CDT group compared to those of TT group were not remarkably significant. But in regard to bleeding complications, TT group (16.67%) was obviously higher than that of the CDT group (8.00%).Conclusion:(1) Catheter-directed thrombolysis was a promising treatment for acute deep venous thrombosis. It could improve thrombolysis effect, reduce dosage of urokinase,shorten the course of disease, reduce the rate of PTS recurrence and does not increase the incidence of complications.(2) The IVCF placement can be effective in preventing PE; retrievable IVCF are recommend.(3) CDT combined with IVCF placement is a simple, safe and effective method of treatment in the treatment of acute lower extremity deep vein thrombosis, which have good application prospects.