| Objective To evaluate the feasibility of creating caval filter-related thrombosis in a swine model and the efficacy of rheolytic thrombectomy in thrombus removal.Method Twenty four pigs were included in this study to create a model of filter-related thrombosis by implanting a filter into inferior vena cava followed by injection of autologous thrombus.Seven,14,28 and 35 days post-operation respectively,rheolytic thrombectomy using AngioJet system was performed for all models to remove the clot.The success rate of model creation,the efficacy of clot removal was analyzed.The following criteria were used in evaluation of thrombolysis:grade I<50%thrombus removal;grade ?=50?90%thrombus removal,and grade ?>90%thrombus removal.Results The success rate of model creation was 100%(24/24).Seven days post creation,3 of 5 pigs attained complete clot removal while 2 pigs achieved partial clot removal.Only 1 pig attained complete colt removeal after 14d post creation.At day 28 and 35,no pigs attained complete clot removal.Conclusion Creating a filter-related thrombosis model in swine is technically feasible.Rheolytic thrombectomy can be safely used to remove filter-related thrombus,and more favorable outcomes can be achieved on fresher clot aged less than 14 days.Objective To evaluate the clinical value of percutaneous AngioJet thrombectomy in treatment of the acute iliofemoral deep venous thrombosis and to discuss its technical points.Method A total of 50 patients with lower extremity deep vein thrombosis verified by color Doppler ultrasound and computed tomographic angiography were included in the study.Inferior vena cava filters were implanted in all patients prior to the thrombectomy.50 patients were randomly divided into 2 groups,25 patients in each group.The guide-wire was inserted and pushed forward to pass through the thrombus in control group,then bolus injection of urokinase(250,000 units)through catheter was performed.Transcatheter micro-pump continuous infusion of urokinase(500,000-750,000units/24h)was employed for 3 to 7 days.Percutaneous AngioJet thrombectomy was performed in observation group,after a mixture of 250,000 U of urokinase in 100 mL of normal saline for local thrombolysis in all patients for approximately 15 minutes.After the thrombectomy procedure,all patients received continuous transcatheter infusion of urokinase(250,000-500,OOOU/d)for 1 to 3 days.When the thrombosis was completely dissolved,the PTA and stents were implanted in those patients who revealed May-Thumer syndrome in the both group.Inferior vena cava filter was retrieved from the patients post procedure and the thrombolytic therapy was discontinued.The patency rate of iliofemoral venous was assessed by CTA at 1 and 6 months after the procedure.Patients were discharged with oral anticoagulation regimen for at least 6 months.The following criteria were used in evaluation of thrombolysis:grade 1<50%thrombus removal;grade ?=50?90%thrombus removal,and grade ?90%thrombus removal.Results The mean duration time of catheter-directed thrombolysis in patients of control group is 129.6±32.2 hours.The average dosage of the urokinase used for thrombolytic therapy was 4,100,000±1,060,000 U(1,750,000-5,500,000 U)and the average time in the hospital was 7.9± 1.4 days.Grade ? lysis was achieved in 10 limbs,grade?lysis in 9 of limbs and grade I lysis in 6 of limbs.In the observation group,all 25 patients were treated by AngioJet thrombectomy device for iliofemoral DVT.The average dosage of the urokinase used for thrombolytic therapy post thrombectomy was 880,000±354,OOOU(500,000-1,750,000 U).The mean duration time of catheter-directed thrombolysis is 42.2±16.7 hours and the average time in the hospital is 3.8±0.8days.Grade ? lysis was achieved in18 limbs and grade ? lysis in 6 of limbs,grade ? lysis only in 1 of limb.The difference of the dosage of urokinase,duration time of catheter-directed thrombolysis,average time in the hospital and clinical effects of thrombectomy were statistically significant between the two groups.There were no recurrent thrombosis in all the patients at 1 month or 6 month after the treatment.Venous patency was maintained in all patients who has been implanted stent.Conclusion Percutaneous AngioJet thrombectomy with adjunctive thrombolytic therapy is an effective,safe treatment modality in patients with acute iliofemoral vein thrombosis.It can improve clinical efficacy of thrombectomy,shorten the length of hospital stay,reduce the overall dosage of the thrombolytic agents,as well as decrease the duration time of thrombolytic therapy and its associated risks. |
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