Evaluation Of The Efficacy Of Proximal Lower Extremities Deep Venous Thrombosis

Objective: To explore the short-and mid-term effects of acute proximal lower extremity deep vein thrombosis(iliofemoral,femoral,and popliteal veins).Results:(1)Short-term curative effect evaluation of group A: Calf edema(limited to the boot area)occurred in 57% of patients.After hospitalization,skin tension of lower limbs was significantly relieved in 35 cases,and partially relieved in0 cases.The pain was obviously relieved in 33 people,and 2 people were partially relieved.After 2 years of follow-up,the incidence of PTS was 17.1%,all of which were mild PTS.Villalta score was 2.23±0.30.CIVIQ-2 score is 22.16±2.90.ThereMethods: A single center retrospectively collected the relevant clinical data of148 patients who were admitted to our department due to Lower Extremity Deep Venous Thrombosis(LEDVT)from 2019 to 2021.According to their own conditions,the patients were divided into group A(35 cases,popliteal vein thrombosis),group B(30 cases,femoral vein thrombosis),and group C(83 cases,iliofemoral vein thrombosis).Both groups A and B were treated with simple anticoagulant therapy.Group C was further divided into group C1 according to the treatment method(28cases,anticoagulant therapy alone),Group C2(25 cases,anticoagulation+inferior vena cava filter implantation+catheter exposure to thrombolytic therapy),Group C3(30 cases,anticoagulation+inferior vena cava filte implantation+Angio Jet mechanical thrombectomy with or without catheter exposure to thrombolysis).The short-term observation indicators include lower limb pain,relief of skin tension,and lower limb swelling rate at discharge.mid-term follow-up indicators include: bleeding and thrombosis recurrence after treatment,PTS incidence and severity(Villalta score),and quality of life(CIVIQ-2 score)in each group at 2 years.were 2 cases of recurrence of thrombus and 2 cases of bleeding-related complications(1 case of blood in stool and 1 case of gingival bleeding).All of which were minor bleeding events.(2)Short-term curative effect evaluation of group B: All patients had symptoms of lower extremity pain,accompanied by varying degrees of calf edema.After admission to the hospital,skin tension of the lower limbs was significantly relieved in29 cases,and 1 case was partially relieved.The pain was obviously relieved in 26 people,and 4 people were partially relieved.After 2 years of follow-up,the incidence of PTS was 26.6%,including 6 mild,1 moderate,and 1 severe.Villalta score was3.51±0.34.CIVIQ-2 score is 25.81±2.55.There were 3 cases of recurrence of thrombus and 1 case of bleeding-related complications(hematuria).All were minor bleeding events.(3)Short-term curative effect evaluation of group C: All patients had symptoms of swelling and pain in different degrees of swelling and calf when they were admitted to the hospital.After admission to the hospital,the symptoms of swelling and pain in the lower limbs of the patient improved.In group C1,21 people had obvious relief of skin tension,7 people had partial relief,26 people had obvious pain relief,and 2 people had partial relief.In group C2,23 people had obvious relief of skin tension,2 people had partial relief,22 people had obvious pain relief,and 3people had partial relief.In group C3,27 people had obvious relief of skin tension,3people had partial relief,28 people had obvious pain relief,and 2 people had partial relief.The circumference difference of the thigh and calf of the affected limb(compared with the healthy side)in groups C1,C2 and C3 after treatment was smaller than that before treatment.The difference in thigh circumference after treatment in group C2 and group C3 was smaller than that in group C1,and the results were statistically significant(P=0.025,P=0.010).The calf circumference difference in group C2 and group C3 after treatment was smaller than that in group C1,and the results were statistically significant(P=0.031,P=0.019).After treatment,the circumference difference between thigh and calf in group C3 was smaller than that in group C2,but the results were not statistically significant.After 2 years of follow-up,the incidence of PTS in group C1,group C2 and group C3 after treatment was 39.3%,24.0%,and 20%,respectively.The incidence of PTS in group C2 and group C3 was lower than that in group C1(P=0.034,P=0.007).The incidence of PTS in group C3 was lower than that in group C2,but the results were not statistically significant.The Villalta scores of group C2 and group C3 were lower than those of group C1(P<0.05),and there was no statistical difference between groups C2 and C3(P>0.05).The CIVIQ-2 score of group C2 and group C3 were lower than those of group C1,and the results were statistically significant(P<0.05).There was no statistical difference between groups C2 and C3(P>0.05).Comparison of bleeding rates in the three groups: the bleeding rates in the three groups were 10.7%,8.0%,and 6.7%,respectively.There was no significant difference in the bleeding rate among the three groups(P>0.05).The recurrence rates of thrombus in group C1,group C2 and group C3 were 25.0%,8.0% and 6.7% respectively.The recurrence rates of group C2 and group C3 were lower than those of group C1(P=0.010;P=0.009).The recurrence rate in group C3 was lower than that in group C2,but the result was not statistically significant(P>0.05).Conclusions: Pharmacomechanical thrombectomy(PMT)+ catheter-directed thrombolysis(CDT)to eliminate iliofemoral vein thrombosis can improve the patency rate of veins and improve the short-term symptoms of patients,and reduce the incidence of PTS in the mid-term.Patients with femoral vein and popliteal vein thrombosis treated with anticoagulation alone have a certain risk of PTS in the mid-term.