Mid-and Short-term Efficacy Of Percutaneous Mechanical Thrombectomy In The Treatment Of Acute Lower Limb Deep Vein Thrombosis

Objective : To analyze the mid-and short-term efficacy and safety of percutaneous mechanical thrombectomy(PMT)via the Angio Jet system in the treatment of acute deep vein thrombosis(LEDVT).Methods:The clinical data of 120 patients admitted in our department for acute LEDVT from January 2018 to June 2020.The short-term therapeutic effects were evaluated based on the changes in the 10 cm circumference difference of the contralateral knee,the venous clinical severity(VCSS)scores and the intraoperative thrombus clearance rate.The mid-term efficacy was evaluated by the incidence of deep vein postthrombotic syndrome(PTS)and the patency of the iliac vein during follow-up.The safety was evaluated by the incidence of pulmonary embolism(PE),hemorrhage and acute kidney injury(AKI).Results: Grades II and III thrombus removal was achieved in 66.7%(80/120)and33.3%(40/120)of patients,respectively.The 10 cm suffering contralateral knee circumference difference decreased from6.31± 2.17 cm preoperatively to3.36±1.04 cm postoperatively.The VCSS score decreased from5.34 ± 1.21 preoperatively to 2.60 ± 1.05 postoperatively.Preoperative and postoperative serum creatinine were 56.03 ± 14.87 and 57.69 ±14.99umol/L.The 10 cm suffering contralateral knee circumference differenceand the VCSS score postoperative were significantly lower than preoperative(p<0.05),and there was no significant difference in serum creatinine between postoperative and preoperative.We found that 94(78.3%)patients had iliac vein compression syndrome(IVCS)intraoperatively and underwent balloon dilation in one stage.Postoperative venography revealed that five patients had many floating thrombi under their inferior vena cava filters,which were not removed.No pulmonary embolism or massive hemorrhage occurred during the perioperative period.The average follow-up time was 13.1±4.3 months.There were 28 patients with Villalta score≥5,the incidence of PTS was 23%,The patency rate of the iliac vein was 78.7%(74/94)after PTA.Conclusions:For the treatment of acute LEDVT,PMT can achieve better short-term effects and has a lower complication rate.However,this study suggests that an inferior vena cava filter should be placed during the operation to intercept the detached thrombus.For patients with deep vein thrombosis and iliac vein compression syndrome,this study recommends that only iliac vein balloon dilatation should be performed in the first stage,and whether to place a stent in the second stage should be determined based on the follow-up results.