| Objective:To analyze and compare retrospectively the clinical efficacy of catheter-directed thrombolysis(CDT)using the small saphenous vein approach,posterior tibial vein approach and popliteal vein approach for acute proximal deep venous thrombosis(DVT).Methods:109 patients,diagnosed with acute proximal deep vein thrombosis and treated by CDT,was collected from September 2017 to December 2019 in Department of vascular surgery of the First Affiliated Hospital of Kunming Medical University,and was divided into three groups according to different catheterization approaches:group A,36 patients with small saphenous vein catheterization;group B,46 patients with posterior tibial vein catheterization;group C,27 patients with popliteal vein catheterization.The difference of therapeutic effect before and after thrombolysis,the difference of therapeutic effect after thrombolysis and the incidence of complications were compared among the three groups.The evaluation indexes include the thigh circumference difference at preoperation and postoperation,the thigh swelling rate,the deep venous patency score,the operation time,thrombolysis time,hospitalization time,intraoperative blood loss,total thrombolysis dose,postoperative complications,etc.SPSS 22.0 software was used for statistical description and analysis.Quantitative data was statistically described as mean±standard deviation(X±S),ANOVA was used for difference analysis between different groups,afterwards multiple comparisons were conducted with SNK-q test;the paired t test was used to compare the differences before and after thrombolysis in each group;the qualitative data was described by the number of cases(composition ratio or rate),and the chi-square test was used to compare the differences between groups.The test level was set as ?=0.05,that is,P?0.05 was considered statistically significant.Results:1.Comparison of three groups of patients before and after thrombolysisGroup A:The circumference difference between affected and normal thigh before and after surgery was(5.62±0.71)cm and(1.42 ± 0.38)cm,the difference was statistically significant(P<0.01);the patency score of the vein before and after surgery were(9.36±2.64)points and(2.53±1.72)points,the difference was statistically significant(P<0.01).Group B:The circumference difference between affected and normal thigh before and after operation was(5.77±0.60)cm,(1.35 ±0.38)cm,the difference was statistically significant(P<0.01);the venous patency score before and after surgery was(8.87±2.55)points and(2.43±1.59)points,the difference was statistically significant(P<0.01).Group C:The circumference difference between affected and normal thigh before and after surgery was(5.42±0.60)cm and(1.32±0.4)cm,the difference was statistically significant(P<0.01);the patency score of the vein before and after the operation was(9.52±2.17)points,(2.44 ±2.10)points,the difference is statistically significant(P<0.01).After thrombolysis therapy,the swelling degree and venous patency of the affected limbs in the three groups were significantly improved.2.Comparison between three groups after thrombolysisAfter thrombolytic therapy in groups A,B,and C,the circumference difference between affected and normal thigh were(1.42±0.38)cm,(1.35±0.38)cm,and(1.32± 0.4)cm,respectively.The differences were not statistically significant(F=0.541,P=0.548>0.05);the swelling rates of the affected limbs in the three groups were(74.66±6.65)%,(76.2±8.39)%,and(75.14 ±8.81)%,with no significant difference(F=0.399,P=0.672>0.05);venous patency scores after thrombolysis were(2.53±1.72)points,(2.43±1.59)points,and(2.44 ± 2.10)points,the differences were not statistically significant(F=0.031,P=0.969>0.05);the improvement of venous patency was(73.08±17.75)%,(71.83±19.96)%,(73.78± 22.3)%,the difference was not statistically significant(F=0.091,P=0.913>0.05);three groups of operation time was(66.44±13.63)min,(69.8±16.53)min,and(54.3±9.11)min,the difference was statistically significant(F=10.691,P<0.05).The intraoperative blood loss in the three groups were(35.11 ± 15.85)ml,(32.35±11.76)ml,and(8.15±3.44)ml,with significant differences(F=45.91,P<0.05).The thrombolytic time of the three groups were(6.39 ±1.02)days,(6.37±0.95)days,and(6.33±1.30)days,with no significant difference(F=0.021,P=0.979>0.05).The total doses of the three groups of thrombolytic urokinase were(316.11±70.72)IU,(308.91±77.67)IU,and(308.89±96.89)IU,with no significant difference(F=0.096,P=0.908>0.05).The total number of hospital stays was(12.22±3.45)days,(13.04 ± 2.76)days,and(12.41±3.02)days,with no significant difference(F=0808,P=0.448>0.05).Comparison between groups showed that the operation time and intraoperative blood loss in group C were smaller than those in groups A and B,and there was no significant difference between groups A and B.3.Comparison of postoperative complications in the three groups9 cases occurred in group A with an incidence rate of 25.0%;12 cases occurred in group B with an incidence rate of 26.1%;1 case occurred in group C with a lower incidence rate of 3.7%.The incidence of complications was different.The incidence of complications in group C was significantly lower than that in groups A and B.The difference was statistically significant(?2=6.065,P<0.05).Conclusion:1.Three approaches of CDT for treating acute proximal deep vein thrombosis all have significant effect and high safety.2.Catheterization via the popliteal vein has more advantages,which can shorten the operation time,reduce complications such as bleeding and incision infection.But clinically,it is necessary to choose a suitable approach in combination with the actual situation. |
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