A Case Control Study Of The Catheter Directed Thrombolysis In Treating Acute Deep Venous Thrombosis Compared With Intravenous Infusion Therapy

Objective： Blood in the venous system changes from liquid into solid,not only impedes the reflux of the blood, but also induces inflammatorychanges of the venous wall or leads to superficial thrombophlebitis of venousthrombosis. Deep venous thrombosis (DVT) is a very common and prevalentdisease in the department of vascular surgery, which is a serious threat topeople’s health. Its risk factors include age, smoking, tumor operation, nausea,long-term bedridden, hypertension, diabetes, etc. Slow blood flow velocity,the injury of vessel wall and blood hypercoagulability are recognized as thecauses of deep venous thrombosis, of which the most common symptoms arelimb swelling, followed by limb pain, varicose veins of lower extremity,movement disorder, and the skin temperature change. Pulmonary embolism(PTE) is the most common and the most dangerous complication of lowerextremity deep venous thrombosis (LDVT), however, its diagnostic rate is low,compared with high mortality. Therefore, to fully understand its risk factors,pathogenesis, clinical manifestations, diagnosis, evaluation and treatments isvery important. This paper will investigate the efficacy of catheter directedthrombolysis though femoral vein puncture in treating acute lower extremityvenous thrombosis.Methods: This study used105patients from2013-5to2014-1in ourhospital, whose swelling time of lower limb is less than72hours and whowere diagnosed by the B type ultrasound and hospitalized for less than14days.The patients were randomly divided into Group A (patents were treated withcatheter directed thrombolysis) and Group B(patient were treated withintravenous infusion therapy). The contralateral femoral vein punctureangiography showed that patients in the Group A had unobstructed iliac vein and inferior vena cava and they were placed with IVC filter in the renal vein.Among them,8cases with the central type of thrombosis were placed withretrograde thrombolysis catheter though the healthy side femoral vein,29cases of peripheral and whole limb type of thrombosis was placed withthrombolysis catheter though ipsilateral posterior tibial vein. The patients in Agroup were treated with urokinase800000U/d though catheter infusion, at thesame time the patients were injected with4100u low molecular weight heparinevery12hours and put on a drip with250ml safflor yellow every day. After7days, the catheter angiography were used for evaluation of thrombolytic effect,and we pulled out the thrombolytic catheter. The patients were also treated toinvigorate the circulation of blood, including the treatment of anticoagulation.They took Warfarin Tablet（smaintaining INR=2-3）.Patients in group B weretreated with800000U/d urokinase through intravenous infusion,at the sametime the patients were also injected with4100u low molecular weight heparinevery12hours and put on a drip with250ml safflor yellow every day for7days, and the treatment of remaining7days were the same with A group.During hospitalization, we measured the double lower limbs diameter fromboth superior border of patella15cm thigh circumference and inferior marginof10cm calf circumference every afternoon (15:00).We aimed to observe andcompare the diameter reduction, the diameter reducing time, the thrombolyticrate and the limb venous filling time of the two groups.Results:1Diameter reduction: After14days treatment, the difference of diameterreduction between the two groups (group A:4.06±1.09cm, group B:2.40±1.14cm) has statistical significance (P <0.05).2Diameter reducing time: After14days treatment, the difference ofdiameter reducing time between the two groups (group A:25.50±4.95s,group B:10.25±6.24s) has statistical significance (P <0.05).3The limb venous filling time: After1month checked out, the differenceof the limb venous filling time between the two groups (group A:1.40±0.55d,, group B:4.23±2.86d)has statistical significance (P <0.05). 4Thrombolytic rate: Group A:0case of grade I(0%),22cases of grade II(59.46%),15cases of grade III (40.54%). Group B:7cases of grade I(10.29%),52cases of grade II (76.47%),9cases of grade III (13.24%). Thedifference was statistically significant (P <0.05).Conclusions:1Catheter directed thrombolysis can improve the treatment of veinthrombosis in diameter reduction, diameter reducing time and thrombolyticrate, compared with intravenous infusion therapy.2Catheter directed thrombolysis has a better long-term effect thanintravenous infusion therapy.