The Clinical Efficacy Of Catheter-directed Thrombolysis With Pulse-spray Infusion Mode In The Treatment Of Patients With Deep Venous Thrombosis

Objective: Deep venous thrombosis(DVT)of lower limbs,mostly multifactorial causes,is the abnormal agglutination of blood,which can obstruct blood flow at the point of clot formation,break free to cause pulmonary thromboembolism(PTE)or damage venous valve function to cause post-thrombotic syndrome(PTS),it has become the serious problem to threaten the people health and safety.Early thrombus removal in patients with DVT aimed to relieve venous obstruction,preserve valve function and reduce PTS morbidity.At present,catheter-directed thrombolysis(CDT)is an effective and safe method to remove blood clots in the treatment of acute DVT.The principle of CDT is that the thrombolytics be delivered to the point of thrombus directly and accumulated in the local area by catheter,So the effect of thrombolysis is enhanced and the bleeding complications are declining.At present,the continuous infusion mode of CDT has been considered effective and safe.However,it's still not clear how effective the pulse-spray infusion mode is in thrombolysis,the medicine is injected into the thrombus with a super-speed through the side hole of catheter.Therefore,pulse-spray infusion mode is likely to have higher efficiency.The aim of this study was to evaluate the effectiveness and safety of catheter-directed thrombolysis with pulse-spray infusion mode in the treatment of DVT.Methods:1 Collecting 50 cases of acute lower extremity DVT patients who were hospitalized in vascular surgery department of Hebei Provincial People's Hospital during June 2014 to December 2015.Entry criteria:1)Diagnosed with DVT of unilateral lower extremity by ultrasoundand/or radiography;2)Suffered a first acute DVT attack in thigh;3)Age?75,the survival period ?1 years;4)Course of disease?7days,D-dimer>500?g/L.Exclusion criteria:1)One had contraindications for anticoagulant,thrombolytic drugs or contrast agents;2)One had the history of cerebral apoplexy and organ hemorrhage in the past 3 months;3)Severe trauma or major surgery in the past 1 months;4)Local or systemic bacterial infection;5)One without the inferior vena cava filter implantation;6)Refractory hypertension(blood pressure>180/110 mmHg);7)Severe heart,lung,liver or kidney function failure.2 All patients were treated with CDT,and according to the infusion model were randomly divided into experimental group with pulse-spray infusion mode(25 cases)and control group with continuous infusion mode(25 cases).Patients underwent CDT via the femoral vein,popliteal vein or posterior tibial vein puncture after placement of vena caval filter.DSA examination was performed every day to observe the situation of thrombus dissolution,and to adjust the location of the catheter.Indications for terminating therapy:1)Thrombus had been completely dissolved;2)There was no obvious change of the thrombus in 2 consecutive days;3)Thrombolysis for 7 days;4)FG<1.0g/L;5)Bleeding complications or secondary infection.3 Main Outcome Measures:3.1 Limb detumescence rate: the difference between the circumference of limbs preoperative was denoted by the letter A,and the difference between the circumference of limbs postoperative was denoted by the letter B,the rate oflimb detumescence=(A-B)/A×100%,it's effective if the rate?50%,otherwise,inefficient.3.2 Venous patency rate: standards of score as follows,0: complete patency;1: patency rate?50%;2: patency rate<50%;3: complete occlusion,the total score is the sum of six parts(iliac veins,external iliac vein,femoral vein,upper superficial femoral vein,lower superficial femoral vein and popliteal vein),preoperative score is set to A,postoperative score is set to B,venous patency rate=(A-B)/A×100%.3.3 The time of thrombolysis: The test recorded the therapy time of each patient for comparing the difference between two groups.3.4 Safety: all 50 cases were observed the changes in serious adverse events(bleeding,pulmonary hemorrhage or hemoptysis),color and temperature of limbs,fibrinogen(FG),clotting time(TT)and D-dimer.Results:1 There were no statistical difference in the gender,limbs,types,age,period,condition and catheter between two groups(P> 0.05).2 Limb detumescence rate: there were no statistical difference between the two groups in the limb detumescence rate of thigh(P>0.05)and shank(P>0.05).3 There were no statistical difference between the two groups in venous patency rate(P>0.05).4 There were statistical difference between the two groups in the time of thrombolysis,the time of thrombolysis were obviously reduced in the experimental group(P<0.05).5 There were no statistical difference between the two groups in complications(P>0.05).Conclusion:1 The pulse-spray infusion mode of CDT was more effictive than continuous infusion mode in the treatment of DVT.2 The pulse-spray infusion mode of CDT was a safe method without increasing the risk of bleeding and PTE.However,the conclusion may existlimitations,due to the factor of small sample size.