| Part 1 A Comparative Study on Improved Catheter- directed Thrombolysis for Acute Lower Extremity Deep Venous ThrombosisObject: To assess the curative effect and security of common catheter-directed thrombolysis(CDT), balloon-assisted catheter-directed thrombolysis for acute lower extremity deep venous thrombosis(DVT).Methods: From September 2008 to December 2011,a total of 100 patients with acute DVT were analyzed retrospectively and were divided into Group A, Group B by admission time. Patients in Group A were enrolled from September 2008 to August 2009, and patients in Group B were enrolled from September 2009 to December 2011. Group A(n=50) and Group B(n=50) were performed common CDT and balloon-assisted CDT, respectively. The circumference differences of thighs and calves between healthy and affected sides before and after treatment, the scores of venous patency before and after treatment, the rates of venous patency, the total doses of urokinase, the thrombolytic time, and the incidences of complication were analyzed statistically.Results: The circumference differences of thighs between healthy and affected sides of Group A and Group B were(5.36±1.98) cm,(5.31±2.29) cm, respectively before surgery without statistical difference(t=0.117 P=0.907). The circumference differences of thighs between healthy and affected sides of Group A and Group B were(2.96±1.00) cm,(1.75±1.53) cm, respectively after surgery with statistical difference(t=4.681 P=0.000). The circumference differences of calves between healthy and affected sides of Group A and Group B were(4.14±1.57) cm,(3.96±1.83) cm, respectively before surgery without statistical difference(t=0.529 P=0.598). The circumference differences of calves between healthy and affected sides of Group A and Group B were(1.94±0.84) cm,(1.29±1.16) cm, respectively after surgery with statistical difference(t=3.204 P=0.002). The scores of deep venous patency in the affected sides of Group A and Group B were 9.00(7.75, 10.00), 9.00(7.00, 10.00) respectively before surgery without statistical difference(Z=-0.703 P=0.482). The scores of deep venous patency in the affected sides of Group A and Group B were 3.50(2.00, 5.00), 0.00(0.00, 1.00), respectively after surgery with statistical difference(Z=-5.832 P=0.000).The rates of deep venous patency of the affected sides of Group A and Group B were 50.00%(41.67%, 71.76%), 100.00%(90.00%, 100.00%)respectively after surgery with statistical difference(Z=-6.068 P=0.000).The doses of urokinase of Group A and Group B were 595.00(547.50, 732.50) x104 U, 390.00(325.00, 500.00) x104 U respectively with statistical difference(Z=-6.508 P=0.000).The thrombolytic time of Group A and Group B was 10.00(9.00, 12.00)d, 6.00(5.00, 7.00) d respectively with statistical difference(Z=-8.256 P=0.000).The incidences of complication of Group A and Group B were 38.00%, 22.00% respectively without statistical difference(X2=3.048 P=0.081).Conclusion: Balloon-assisted catheter-directed thrombolysis which crushes thrombosis through balloon dilatation firstly, and then performs catheter-directed thrombolysis can improve the rate of deep venous patency, efficiency of thrombolysis, reduce the dose of urokinase, cut down the thrombolytic time for acute lower extremity DVT. The efficacy of balloon-assisted catheter-directed thrombolysis is superior to the common catheter-directed thrombolysis.Part 2 A Comparative Study on Improved Catheter- directed Thrombolysis for Acute Left Lower Extremity Deep Venous Thrombosis Complicated by Iliac Vein StenosisObject: To assess the curative effect and security of common catheter-directed thrombolysis(CDT), balloon-assisted catheter-directed thrombolysis, and stent-assisted catheter-directed thrombolysis for acute lower extremity deep venous thrombosis(DVT) complicated by iliac vein stenosis in left.Methods: From January 2012 to April 2014, a total of 53 patients with acute DVT complicated iliac vein stenosis in left were enrolled and were randomly divided into Group A, Group B and Group C. Group A(n=20), Group B(n=20) and Group C(n=13) were performed common CDT, balloon-assisted CDT, stent-assisted CDT respectively. The circumference differences between normal and affected limbs, scores of deep venous patency, and rates of venous patency were recorded to evaluate the efficacy. The total doses of urokinase and time of thrombolysis were compared across the three groups. The incidences of complications were used to evaluate the safety of treatment. The above data were analyzed statistically according to their types. Measurement data with normal distribution were described by mean ± standard deviation, and were analyzed using T test. Measurement data with non-normal distribution were described by M(QL, QU), QL=P25, QU=P75, and were analyzed using Wilcoxon’s test. Categorical variable data were analyzed using Chi-Square test.Results: In Group A, the circumference differences of thighs and calves between healthy and affected sides were(4.43±2.30) cm,(3.62±1.72) cm, respectively before surgery. The score of deep venous patency in the affected side was 10.00(6.00, 11.75) before surgery. The circumference differences of thighs and calves between healthy and affected sides were(2.80±1.33) cm and(1.83±1.02) cm, respectively after surgery. The score of deep venous patency in the affected side was 2.50(1.25, 4.00) after surgery. The rate of deep venous patency of the affected side, the dosage of urokinase, the time of thrombolysis andthe rate of complication were 71.82%(50.00%, 83.33%), 450.00(322.50, 645.00) x104 U, 8.00(6.25, 11.00) d and 15.00% respectively. In Group B, the circumference differences of thighs and calves between healthy and affected sides were(5.34±2.93) cm,(3.87±2.25) cm, respectively before surgery. The score of deep venous patency in the affected side was 9.50(7.25, 12.00) before surgery. The circumference differences of thighs and calves between healthy and affected sides were(1.75±1.33) cm and(1.15±0.97) cm, respectively after surgery. The score of deep venous patency in the affected side was 1.00(1.00, 1.00) after surgery. The rate of deep venous patency of the affected side, the dosage of urokinase, the time of thrombolysis and the rate of complication were 89.45%(83.93%, 91.67%), 285.00(232.50, 375.50) x104 U, 6.00(5.00, 6.00)d and 5.00% respectively. In Group C, the circumference differences of thighs and calves between healthy and affected sides were(5.23±1.59) cm and(3.85±1.41) cm, respectively before surgery. The score of deep venous patency in the affected side was 9.00(6.50, 10.50) before surgery. The circumference differences of thighs and calves between healthy and affected sides were(0.46±0.78) cm,(0.42±0.49) cm, respectively after surgery. The score of deep venous patency in the affected side was 0.00(0.00, 1.00) after surgery. The rate of deep venous patency of the affected side, the dosage of urokinase, the time of thrombolysis and the rate of complication were 100.00%(90.28%, 100.00%), 120.00(100.00, 197.50) x104 U, 3.00(2.00, 4.00) d and 0.00% respectively. The circumference differences of thighs and calves between healthy and affected sides, the score of deep venous patency in the affected side before and after treatment were with statistical difference in every group(P<0.05). Among the three groups, the circumference differences of thighs and calves between healthy and affected sides, the scores of deep venous patency before surgery were without statistical difference(P>0.05). The circumference differences of thighs and calves between healthy and affected sides after surgery were statistically significant(P<0.05) across the three groups- Group A vs Group B(t=2.492 P=0.017, t=2.143 P=0.039), Group A vs Group C(t=5.712 P=0.000, t=4.613 P=0.000), Group B vs Group C(t=3.146 P=0.004, t=2.481 P=0.019). The scores of deep venous patency in the affected side after surgery were statistically significant(P<0.05) across the three groups- Group A vs Group B(Z=-3.331 P=0.001), Group A vs Group C(Z=-3.785 P=0.000), Group B vs Group C(Z=-2.675 P=0.007). The rates of deep venous patency of the affected side after surgery were statistically significant(P<0.05) across the three groups- Group A vs Group B(Z=-3.327 P=0.001), Group A vs Group C(Z=-3.798 P=0.000), Group B vs Group C(Z=-2.637 P=0.008). The doses of urokinase were statistically significant(P<0.05) across the three groups- Group A vs Group B(Z=-3.803 P=0.000), Group A vs Group C(Z=-4.571 P=0.000), Group B vs Group C(Z=-3.947 P=0.000). The time of thrombolysis was statistically significant(P<0.05) across the three groups- Group A vs Group B(Z=-3.484 P=0.000), Group A vs Group C(Z=-4.513 P=0.000), Group B vs Group C(Z=-4.259 P=0.000). The rates of complication were without statistical difference(P>0.05) across the three groups- Group A vs Group B(X2=1.111 P=0.292), Group A vs Group C(X2=2.145 P=0.143), Group B vs Group C(X2=0.670 P=0.413).Conclusion: For the treatment of acute left lower extremity deep venous thrombosis complicated by iliac vein stenosis, balloon-assisted catheter-directed thrombolysis and stent-assisted catheter-directed thrombolysis can improve the rate of deep venous patency, efficiency of thrombolysis, reduce the dosage of urokinase, cut down the time of thrombolysis. The efficacy of balloon-assisted catheter-directed thrombolysis and stent-assisted catheter-directed thrombolysis is better than that of the common catheter-directed thrombolysis. Early correction of iliac vein stenosis can improve the efficacy of catheter thrombolysis, reduce the dosage of urokinase, cut down the time of thrombolysis, but need further study confirmed. |
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