The Application And Efficacy Observation Of Percutaneous Mechanical Thrombectomy In Patients With Deep Venous Thrombosis Of Lower Extremity

ObjectivePercutaneous mechanical thrombectomy(PMT)is currently one of the methods for the treatment of lower extremities deep venous thrombosis(DVT).Angio Jet is a representative device,but the current efficacy of PMT is still controversy.Retrospective study aims to evaluate the efficacy and application of PMT in the treatment of iliac-femoral DVT patients,especially in patients with high bleeding risks,to provide a theoretical basis for clinical treatment.MethodsA retrospective analysis of 117 patients with acute iliac-femoral DVT admitted to the Department of Vascular Surgery of the nine People’s Hospital of Shanghai Jiaotong University School of Medicine from September 2015 to January 2017,and according to the risk of bleeding,it was divided into two subgroups,85 cases included in low-bleeding risk group(low-risk group,no bleeding risk factor),32 cases included in high-bleeding risk group(high-risk group,≥ 1 bleeding risk factor).All patients were treated with Angio Jet device thrombectomy,followed by sequential CDT or stent implantation.The general data and surgical parameters of the patients were collected,and the postoperative bleeding events and other complications,the 1-year patency rate and the Villalta score were compared betweenthe two groups.ResultsThe male ratio was 47.01%,the left lower limbs were 76.92%,the average age was 57.36±16.23 years,and the onset time was 5.97±4.32 days.Six patients had preoperative pulmonary embolism(PE).There were no major complications such as major bleeding events,death or renal failure and so on.There were 10 cases of puncture site bleeding and 3 new cases of symptomatic PE.The patency rate was88.03% after 1 year follow-up.The VRI score is lower than that before surgery,and the difference was statistically significant(3.03±1.84 vs 12.67±1.34).There were14 patients developed the symptoms of PTS,but the overall Villalta score was low(2.47±1.36).Subgroup analysis suggested that the mean age of the high-risk group was higher than that of the low-risk group(63.97±19.33 vs 54.87±14.25,P<0.05).The high-risk group did not receive CDT,and the CDT time of the low-risk group was 1.94±0.74 days.There was no significant difference in the incidence of bleeding events and postoperative complications(p>0.05).The results of follow-up Villalta score(2.44±1.26 vs 2.56±1.63.,p = 0.65)and 1-year patency rate(87.06% vs90.62%),p = 0.60)were similar.ConclusionPMT in the treatment of iliac-femoral DVT patients has early satisfactory and safe results,with low incidence of major bleeding events and serious complications,and has the potential in the treatment of patients with high risk of bleeding.