The Clinical Study Of The Pharmacomechanical Thrombectomy For Acute Lower Extremity Deep Venous Thrombosis

Object: To investigate the technical feasibility and procedural outcomes of Endovascular interventional therapy for acute lower extremity deep venous thrombosis with Angio Jet Ultra thrombectomy system.Methods:Retrospective analysis of clinical data of 60 patients with acute lower extremity deep venous thrombosis in our hospital from September 2012 to March 2016. Group A were treated in September 2012 to May 2014, a total of 32 cases were treated with catheter-directed thrombolysis; B group was treated in June 2014 to March 2016, a total of 28 cases, were treated with Angio Jet thrombus removal device. The circumference difference between normal and affected limbs, the limb edema reduction rates, scores of venous patency, postoperative deep vein patency rate were recorded for judging the efficacy. and two groups with urokinase and the total time of thrombolysis, hospitalization time were statistically analyzed. The incidence of complication of bleeding were used to judge the safety of treatment.Results:The circumference differences of thighs between healthy and affected sides of Group A and Group B were(5.09±2.67) cm,(5.31±2.29) cm, respectively before surgery without statistical difference(t=0.134 P=0.894). The circumference differences of thighs between healthy and affected sides of Group A and Group B were(1.41±1.88) cm,(1.29±1.46) cm, respectively after surgery without statistical difference(t=0.274 P=0.785); The circumference differences of calves between healthy and affected sides of Group A and Group B were(4.15±1.89) cm,(3.92±1.92) cm, respectively before surgery without statistical difference(t=0.462 P=0.646). The circumference differences of calves between healthy and affected sides of Group A and Group B were(1.41±1.29) cm,(1.39±1.23) cm,respectively after surgery without statistical difference(t=0.041,P=0.967). The differences of limb edema reduction rates([73.59±25.22] % vs [75.32±23.18]%,P>0.05).The scores of deep venous patency in the affected sides of Group A and Group B were 7.00(6.00,7.00),7.00(4.00,7.75) respectively before surgery without statistical difference(Z=-1.020,P=0.308). The scores of deep venous patency in the affected sides of Group A and Group Bwere 1.00(0.00,2.00),0.00(0.00,1.00)respectively after surgery without statistical difference(Z=-2.265, P=0.374).The rates of deep venous patency of the affected sides of Group A and Group B were 82.00%(71.00%,100.00%),100.00%(90.28%,100.00%)respectively after surgery without statistical difference(Z=2.305, P=0.081). The doses of urokinase of Group A and Group B were(204.38±108.27)x104U,(113.93±61.00)x104U respectively with statistical difference(Z=-3.896,P=0.000). The thrombolytic time of Group A and Group B was(5.11±2.57)d,(2.61±1.62)d respectively with statistical difference(Z=-4.073,P=0.000). hospitalization time([9.19±2.26]d vs [7.75±1.38]d, P=0.008) were statistically significant between group A and group B. The incidences of complication of Group A and Group B were 53.10%, 7.10% respectively with statistical difference(χ2=12.54, P=0.002).Conclusion: Under the protection of inferior vena cava filter,the treatment of acute lower extremity deep venous thrombosis with Angio Jet thrombus removal device has no significant difference compared with CDT. But Angio Jet Ultra thrombectomy system can significantly improve efficiency of thrombolysis and reduce the dose of urokinase, shorten the thrombolytic time and hospitalization time, achieve good short-term efficacy, mid and long-term efficacy need further follow-up and safety well, so it is worthy of further clinical research.