| Objective:Retrospective analysis of the efficacy in treating mixed acute deep venous thrombosis with different approaches CDT.Methods:From January 2012 to December 2015,118 mixed DVT patients were be divided into three groups.Group A had 23 cases which were the contralateral femoral vein catheterization.Group B had 30 cases which were the small saphenous vein catheterization.Percutaneous anterior tibial or posterior tibial vein catheterization was group C which included 65 cases.Evaluating and analyzing the efficacy of three groups preopration and post opration,complications and the difference of the incidence of complications respectively in long-term follow-up.The evaluation included the thigh and calf circumference difference preopration and post opration,limb swelling rate,deep vein patency rate,thrombus clearance after surgery,operation completion time,the incidence of postoperative complications after 2 year follow-up.Results:1.The swell of Limb were be greatly improved after the opration for all patients.The circumference between affected and nomoal thigh of group A before and after the thrombolysis were(5.53±0.42)cm,(1.78±0.53)cm.(t=4.63,P<0.05).The circumference between affected and nomoal calf of group A before and after the thrombolysis were(4.96±0.54)cm,(2.13±0.65)cm.(t=3.32,P<0.05).The venous patency score before and after the thrombolysis were(8.95±1.63),(4.26±1.26).(t=6.37,P<0.05).The circumference between affected and nomoal thigh of group B before and after the thrombolysis were(5.46±0.38)cm,(1.85±0.68)cm.(t=4.68,P<0.05).The circumference between affected and nomoal calf of group B before and after the thrombolysis were(4.81±0.45)cm,(1.75±0.59)cm.(t=3.16,P<0.05).The venous patency score before and after the thrombolysis were(8.77±1.43),(3.27±1.59).(t=6.43,P<0.05).Thecircumference between affected and nomoal thigh of group C before and after the thrombolysis were(5.67±0.46)cm,(1.72±0.56)cm.(t=4.63,P<0.05).The circumference between affected and nomoal calf of group C before and after the thrombolysis were(5.03±0.64)cm,(1.72±0.62)cm.(t=3.32,P<0.05).The venous patency score before and after the thrombolysis were(8.35±1.78),(3.35±1.38).(t=6.28,P<0.05).2.The circumference between affected and nomoal thigh among three groups after the thrombolysis were(1.78±0.53)cm,(1.85±0.68)cm,(1.72±0.56)cm respctively.(F=0.51,P>0.05);The swelling ratio of thigh among the three groups were(70.72±15.67)%,(68.39±17.25)%,(73.95±17.33)%.(F=1.17,P>0.05).The circumference between affected and nomoal calf among three groups after the thrombolysis were(2.13±0.65)cm,(1.75±0.59)cm,(1.72±0.62)cm respctively.(F=4.11,P<0.05).The swelling ratio of calf among the three groups were(55.82±17.63)%,(66.28±18.26)%,(67.95±17.32)%.(F=4.11,P<0.05).Group B and C were more well than group A about swollen elimination,B and C were similar.The thrombus clearance score of three groups were(2.55±0.16),(2.68±0.19),(2.65±0.20)respctively.(F=3.31,P<0.05).Venous patency score of three groups were(4.26±1.26),(3.27±1.59),(3.35±1.38)respctively.(F=3.59,P<0.05).Group B,group C were higher than group A in Venous patency score and venous thrombus clearance score.The total operation time of three groups were(65.27±5.42)min,(69.36±4.19)min,(52.33±4.25)min.(F=174.43,P<0.05).Group C was less than group A and B in the operation time.The total amount of urokinase were(435.30±56.45)*104IU,(383.59±52.39)*104IU,(375.35±58.20)*104IU,(F=9.77,P<0.05);The total time of thromblysis were(7.37±1.35)d,(6.25±1.48)d,(6.42±1.39)d.(F=4.87,P<0.05).B and C were Less than group A in these aspects.3.The incidence of total complications of three groups were 17.4%,20%,15.4%.(x~2=0.32,P>0.05).4.101(85.59%)patients complete 3-24 months follow-up,the median time was20.4 months and 17 cases were lost follow-up.83 patients had been implanted stent,73 cases complete follow-up,the stent patency was 89.04% after 2 years.5 cases had stent restenosis,3 cases had stent thrombosis and restenosis.The incidence of PTS of three groups were 40%,12.50%,14.04%.(x~2=7.65,P=0.02).PTS score of threegroups were(6.36±1.35),(4.53±1.56),(4.28±1.23).(F=20.90,P<0.00).Group B and C had no difference in the incidence of PTS and PTS score,but were all lower than group A;Thrombosis recurrence rate of three groups were10%,8.33%,7.02%.(x~2=0.19,P>0.05).Thrombosis recurrence rate of all patients was 7.92%.Conclusion:1.Percutaneous anterior tibial or posterior tibial vein catheterization is shorter time,simple operation,other surgical approaches can be used as alternatives.2. Three catheter thrombolysis approaches treating acute lower limb DVT is effect.The risk of surgical treatment and incidence of complications after 2 years are low.The efficacy of antegrade venous catheter is better than the retrograde venous catheter.4.The efficacy of PTA and stent placement treating patients with IVCS is sure.2 years follow-up,patency rate of stent is high. |
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