Clinical Analysis Of Interventional Synthetic Therapy In216Cases Of Deep Venous Thrombosis Of Lower Extremity

Objective: On the basis of summarizing the domestic and internationalexperiences of various methods for deep venous thrombosis of lower extremitytreatment, we utilize the Catheter directed thrombolysis, Trans-dorsalis pedis veinthrombolysis, complemented by Percutaneous transluminal angioplasty andendovascular stent implantation of lower extremity deep vein, to cure DVT. Evaluatethe clinical efficacy of patient hospitalization and follow-up period by retrospectiveanalysis. We conducted group comparison therapeutic effects according to differenttreatment modality, hoping to find superior treatment programmes, with a view tofurther clinical treatment guidance.Methods: Retrospective analysis216confirmed cases of lower extremity deepvein thrombosis in hospitalized patients with clinical data from November2006toNovember2011,5years. All cases were divided into treatment group and control groupaccording to treatment modality, treatment group was treated with interventionalsynthetic therapy+anticoagulant therapy, while control group received anticoagulanttherapy alone. We divided treatment group into CDT(Catheter directed thrombolysis)group and TPVT(Trans-dorsalis pedis vein thrombolysis) group, patients during theperiod of follow up were divided into anticoagulant group, CDT group and TPVT groupto compare the medium and long-term clinical curative effect.Circumference differences between the affected limbs and healthy limbs arecalculated to evaluation of swelling reduction; Refer to Porter’s vein patency of thejudgment standard, in the treatment group, the venous venography and ultrasounddiagnosis is performed to evaluate the venous recanalization condition. In the controlgroup, the venous ultrasound diagnosis is performed to evaluate the venousrecanalization condition. Patients were followed up through outpatient referral and telephone contact, we investigated the status of patients with lower limb, living andworking status, To know status of recurrence of deep vein thrombosis and theoccurrence of PTS. We used Villalta score sheet as the PTS (post-thrombotic syndrome)diagnosis and grading standards. And venous disability score (VDS). The statisticalanalysis of all obtained data was performed on computer by the SPSS17.0statisticssoftware, the chi-square test was applied to compare the differences of the enumerationdata,differences in measurement data were compared with T test and variance analysis.Results: After patients received the medical treatment in hospital,All patientswere cured or improved,average hospital stay9.4days,venous patency improved rate inpatients treatment group(48.6±24)%is significantly higher than the controlgroup(18.2±17)%;Through statistical analysis with significant differences(P=0.000<0.01). The swelling reduction rate is no much difference between twogroups(P=0.076>0.05). Venous patency improved rate in CDT group is significantlybetter than TPVT group, with statistically significant(P<0.05).The durations of follow-ups for (38±12) months, effective follow-up in145cases,follow-up rate67%, No VTE related deaths; One patient affected with therecurrence of DVT; The PTS was diagnosed in23patients followed, incidence of PTSwas15.8%; All patients were followed up for VDS score, the average score was1.28points. Circumference differences between the affected limbs and healthy limbs,incidence and severity of PTS in CDT group is significantly better than anticoagulantgroup and TPVT group, the difference is significant(P<0.05);There is no significantdifference between TPVT group and anticoagulant group; The average VDS score inCDT group and TPVT group is significantly lower than anticoagulant group,Chi-squaretest confirmed that the difference was statistically significant(P<0.05) and there is nosignificant difference between CDT group and TPVT group(χ~2=5.722，P>0.05).27bleeding events were detected during hospitalization，all the patients relievedafter symptomatic treatment. No fatal hemorrhage and hemorrhagic shock, no deathcases. New-onset PTE appeared on three cases of patients undergoing lower extremityvenography, all the patients relieved after symptomatic treatment, neither recurrence ofsymptoms after IVCF implantation. No complications of Endovascular therapy.83patients have taken the treatment of inferior vena cava filter implantation, temporaryfilter for2patients, Examination revealed that1patient’s temporary filter falls off to theright atrium three weeks after operation, then reclaimed the filter, no serious arrhythmiaand other complications. In81cases, the filters were placed in permanently, the filters in3patients were attached with large blocks of thrombuses， symptoms weresignificantly relieved after active anticoagulant therapy.28patients Accept CT review,no filter shift, fall off, fracture and symptom-type PTE occurred. The iliac vein dilationand stent implantationwas performed to2patients,all of them were regularly reviewed,no stent migration and restenosis. No fatal hemorrhage happened in all patients takenorally Warfarin for anticoagultion therapy during follow up period.Conclusion: Using interventional synthetic techniques combined withanticoagulation therapy has a definite curative effect on DVT of low extremities,byclinical observation and follow-up evaluation. By using the catheter directedthrombolysis combined with anticoagulation therapy to cure DVT of low extremities,we can significantly improve the recanalization rate and for the thrombus affected veins,incidence of PTS can be reduced and the clinical symptoms of PTS can be eased.Current and long-dated curative effect are superior to Trans-dorsalis pedis veinthrombolysis and anticoagulation alone.