The Application Of Angiojet Rheolytic Thrombectomy In The Endovascular Treatment Of Lower Extremity Deep Venous Thrombosis

Object To evaluate the clinical safety and effectiveness of percutaneous rheolytic thrombectomy in patients with acute lower extremity deep venous thrombosis.Methods The clinical data of patients with acute lower extremity deep venous thrombosis treated in the Department of Vascular surgery of our hospital from August 2016 to August 2018 were analyzed retrospectively.Without contraindications of thrombolysis,CDT or PMT depended on the patient's preference.They were divided into two groups: PMT group(n=24)and CDT group(n=32).The short-term efficacy,safety and follow-up effect of the two groups were analyzed and compared.The indexes of short-term efficacy included Venous Registry Index(VRI)before and after treatment,thrombolysis rate after treatment,total dose of urokinase,thrombolysis time,hospitalization time and clinical efficacy,etc.The safety index mainly refers to the occurrence of complications in the two groups of patients.Follow-up indicators included thrombus recurrence and stent patency.The prevalence of post-thrombotic syndrome(PTS)in the follow-up was assessed according to the Villalta scale.Results VRI changed from 9.04 ± 1.40 preoperatively to 1.75 ± 1.33 postoperatively in the PMT group(t=0.560,P=0.578),and from 8.81 ± 1.60 to 2.03 ± 1.33 in the CDT group(t=-0.783,P=0.437).Thrombolysis rate was 80.32%± 15.67% and 76.70%± 15.90% in the PMT and CDT groups,respectively(t= 0.847,P= 0.401).In PMT group,grade ? thrombolysis was achieved in 10 limbs,grade ? lysis in 13 limbs and grade ? lysis in 1 limb.In CDT group,grade ? thrombolysis was achieved in 8 limbs,grade ? lysis in 22 limbs and grade ? lysis in 2limbs.There were no differences in thrombus score,VRI and thrombolytic effects between the 2groups.The clinical outcomes of the two groups were similar.Symptomatic pulmonary embolism and major bleeding were not observed during the hospitalization.The incidence of complications in PMT group and CDT group was 8.33%(2/24)and 34.38%(11/32)respectively,and the difference was statistically significant(c(17)=5.218,P=0.022).Thrombolysis time was(0.5,0.17h)and(216,96h)in the PMT and CDT groups,respectively(Z=-6.413,P=0.000).Hospitalization time was(9,4d)and(12,4d)in the PMT and CDT groups,respectively(Z=-3.593,P=0.000).The average dosage of urokinase was(0.25,0.10 million IU)and(3.90,3.00 million IU)in the PMT and CDT groups,respectively(Z=-6.378,P=0.000).The dosage of urokinase,thrombolysis timeand hospitalization time were statistically different between the two groups(all P<0.05).The Villalta scale was(3,2)in the PMT group and(3.5,2)in the CDT group(Z=-0.321,P=0.748).There was no significant difference between CDT group and PMT group in Villalta scale.Conclusion Both PMT and CDT are effective treatment modalities in patients with acute proximal DVT.PMT is similar to CDT in terms of both ensuring venous patency and improving clinical symptoms,but hospital stay,urokinase dosage,and thrombolysis time were less compared with patients who received CDT only.This technique is a safe,effective and easily performed method of endovascular treatment with a low rate of small bleeding events and infection and shows promising clinical short-term results.