The Clinical Effect Of Balloon Dilatation Assist With Catheter-directed Thrombolysis Treat For Acute Iliac Femoral Venous Thrombosis

Research background and ObjectiveAcute iliac femoral venous thrombosis?IFVT?is a common peripheral vascular disease.The main features are acute onset,swelling of the whole lower extremity,and skin temperature rise.If the treatment is not appropriate,it will be converted into post thrombotic syndrome?PTS?in the long term,which seriously affects the quality of life of patients^[1].IFVT is an independent risk factor for PTS.Even in the case of long-term anticoagulation,the incidence of PTS is as high as 20%to 50%^[2].Although catheter-directed thrombolysis?CDT?is effective in the treatment of IFVT^[3],there are still shortcomings such as a long thrombolysis cycle and a high risk of bleeding.Therefore,how to further improve the efficacy and safety has become the key to current clinical treatment.The balloon dilatation assist with CDT provides new ideas for the treatment of acute IFVT,but there are few controlled studies compared with traditional treatment,and its effectiveness and safety still need to be confirmed.The purpose of this subject was to compare and analyze the difference?such as:effective,safe,length and cost of hospitalization,and long-term prognosis?between the balloon-assisted CDT and systemic thrombolysis or CDT alone.In order to provide some reference opinions for the selection of acute IFVT treatment.MethodsThe clinical data of 107 patients with IFVT admitted from December 2017 to January 2019 were retrospectively analyzed.They were divided into 3 groups according to different treatment methods.Group A?35 cases?were treated with dorsal foot vein thrombolysis,Group B?37 cases?were treated with CDT alone,and Group C?35 cases?were treated with the balloon dilatation assist with CDT.Collect relevant clinical data of the patient,and follow up with telephone and outpatient services.During the follow-up,double-venous deep vein angiography or vascular color Doppler ultrasound should be reviewed.Results SAS 9.4 statistical software was used for statistical analysis to compare the changes of peripheral diameter of lower limbs,the degree of venous patency,the incidence of bleeding,thrombolysis time,urokinase dosage,coagulation function,the incidence of long-term PTS,the length of hospitalization and cost among the three groups.and to explore the factors influencing the prognosis of venous patency.P<0.05 is considered statistically significant.Results1.There was no statistically significant difference between the thigh and calf and peripheral diameter difference of affected side in the three groups before treatment?P>0.05?.The difference between the thigh and calf and peripheral diameter difference of affected side was statistically significant 10 days after treatment in the three groups?P<0.05?.SNK pairwise comparison:Group C was less than Group A and Group B?P<0.05?.2.There was no statistically significant difference in the venous patency scores between the three groups before treatment?P>0.05?.While the comparision of venous patency scores in three groups was statistically significant 10 days after treatment?P<0.05?.SNK pairwise comparison:Group C was less than Group A and Group B?P<0.05?.The venous patency rate of the three groups was statistically significant at10 days and 6 months after treatment?P<0.05?.SNK pairwise comparison:Group C was better than Group A and Group B?P<0.05?.3.The incidence of bleeding in the three groups was as follows:Group A22.86%?8/35?,Group B 10.81%?4/37?,Group C 2.86%?1/35?,the difference was statistically significant?P<0.05?.4.There was a statistically significant difference in thrombolysis time and urokinase dosage between the three groups?P<0.05?.SNK pairwise comparison:Group C was shorter?less?than Group A and Group B?P<0.05?.5.There was no statistically significant difference in coagulation function between the three groups before treatment and 10 days after treatment?P>0.05?.6.The follow-up results of 6 months and 12 months after treatment in the three groups showed that the incidence of PTS in Group C was significantly lower than that in Group A and Group B,the difference was statistically significant?P<0.05?.7.The average hospital stay in Group C was lower than that in Group A and Group B,the difference was statistically significant?P<0.05?.There was no statistically significant difference in the average hospital stay between Group A and Group B?P>0.05?.The average hospitalization cost of Group A was lower than that of Group B and Group C,the difference was statistically significant?P<0.05?.Comparing the average hospitalization costs of Group B and Group C,the difference was not statistically significant?P>0.05?.8.The results of the logistic regression model reveals that the influence of different treatment methods and the difference in thigh circumference on the prognosis of venous patency rate is statistically significant?P<0.05?.Compared with Group C,Group A?OR=0.003,95%CI:0.002?0.005,P=0.0119?and Group B?OR=0.015,95%CI:0.002?0.870,P=0.0484?were less effective,the prognosis of venous patency rate in the Group C is more likely to be greater than 50%.After treatment,the greater the difference in thigh circumference?OR=0.352,95%CI:0.135?0.921,P=0.0333?,the prognostic effect is worse and the venous patency rate is more likely to be less than 50%.However,the influence of gender,age,urokinase dosage and thrombolysis time on the prognosis of venous patency was not statistically significant?P>0.05?.Conclusions1.All three methods are effective for the treatment of IFVT.2.The balloon dilatation assist with CDT treatment of IFVT is better than simple CDT and systemic thrombolysis,and it will not affect the patients'coagulation function.3.Although the balloon dilatation assist with CDT treatment of IFVT has a high hospitalization cost,it has the advantages of short treatment period,less thrombolytic drugs,low incidence of PTS,high prognosis of venous patency rate and high safety,which is worthy of promotion and application.