Comparative Study About The Clinical Results Of Acute Massive Pulmonary Embolism Treated By AngioJet Rheolytic Thrombectomy And Catheter Directed Thrombectomy

ObjectiveTo analyze the clinical results of acute massive pulmonary embolism treated by AngioJet rheolytic thrombectomy and catheter directed thrombolysis.MethodsAccording to the comparative study,collected the data of 33 patients who was diagnosed with acute massive pulmonary embolism cured by AngioJet rheolytic thrombectomy and 32 patients who was diagnosed with acute pulmonary embolism cured by catheter directed thrombolysis in our hospital,from October,2017to December,2019.And following different surgical ways,patients were divided into AngioJet rheolytic thrombectomy's group and catheter directed thrombolysis'group.There are 33 patients in AngioJet rheolytic thrombectomy's group who are 15 males and 18 females,their average ages?53.8±13.1?y.And the catheter directed thrombolysis'group has 32 patients whose average ages?56.8±12.3?y,consist of 18 males and 14females.They take different operations.Moreover,the patients in the catheter directed thrombolysis'group take catheter removal operation after urokinase thrombolysis?400,000-500,000 per time?twice a day.all patients have to take pulmonary artery pressure tests,blood test,hepatorenal function,B-type natriuretic peptide,diameter propotion of right ventricular and left ventricular at pre-operation,3^rd and 3 months of post-operation.These patients accept anticoagulated therapy 3-6 months used by low molecular weight heparin?100U/Kg?twice a day in hospital and rivaroxaban 15 mg once a day after discharge.And they have a regular follow-up in1,3,6 and 12 months,through these examinations of computed tomography pulmonary angiography,ultrasound,blood test and etc.to estimate the pulmonary artery pressure,right heart function recurrence pulmonary embolism and other situations.Collect relative clinic data about these patients,and use SPSS 22.0 to analyze two groups'disease time,inpatient days,operative time,changes of pulmonary artery pressure and right heart function,operative success rate,complication situation and mortality.Results1.The patients'in AngioJet rheolytic thrombectomy's group average disease time is?2.1±1.5?d,average operative time?95.2±16.6?min,average inpatient days?9.5±1.7?d,technological success rate 100%,operative success rate 90.9%?30/33?,complication rate 6.1%?2/33?and mortality 9.1%?3/33?.Meanwhile,the changes of pulmonary artery pressure and right heart function in post-operation 3 days and 3 months are significant?p<0.05?.2.The patients'in catheter directed thrombolysis'group average disease time is?2.1±1.3?d,average operative time?23.1±1.5?min,average inpatient days?9.5±1.6?d,technological success rate 100%,operative success rate 87.5%?28/32?,complication rate 9.4%?3/32?and mortality 28.1%?9/32?.Meanwhile,the changes of pulmonary artery pressure and right heart function in post-operation 3 days and 3 months are significant?p<0.05?.3.Compared in AngioJet rheolytic thrombectomy's group and catheter directed thrombolysis'group,these are insignificant?p>0.05?in ages,disease time,inpatient days,technological success rate,operative success rate and complication situation.But mortality and operative time are significant between AngioJet rheolytic thrombectomy and catheter directed thrombolysis?p<0.05?.Compared of the changes of pulmonary artery pressure,two groups have significant in 3 day?p<0.05?,but insignificant in 3 months?p>0.05?.Whatever in 3 days or 3 months,the change of right heart function has significant?p<0.05?between two groups.Conclusions1.AngioJet rheolytic thrombectomy for treating massive pulmonary embolism has a high operative successful rate and low mortality,which also cure the acute pulmonary embolism with thrombolytic contraindication.2.Catheter directed thrombolysis'operative time is shorter than AngioJet rheolytic thrombectomy,and they have a similar result about decreasing pulmonary artery pressure in the long-term.But in the short-time,the effect of AngioJet rheolytic thrombectomy in decreasing pressure more remarkable than catheter directed thrombolysis.From the short-term and long-term,the effect of AngioJet rheolytic thrombectomy in improving heart function more remarkable than catheter directed thrombolysis.