Efficacy And Risk Assessment Of Endovascular Treatment For Acute Deep Venous Thrombosis Of Lower Extremities

Objective To investigate and compare the efficacy and safety of percutaneous mechanical thrombectomy(PMT)combined with catheter directed thrombolysis and catheter directed thrombolysis alone in the treatment of acute lower extremity deep venous thrombosis.Methods From January 2018 to December 2018,78 patients with acute deep vein thrombosis of lower extremities who were admitted to the department of vascular surgery of xinjiang uygur autonomous region people's hospital and met the clinical criteria for inclusion in this study were selected as subjects.Seventy-eight patients(93 limbs)with an average age of 59.7 years underwent PMT combined with CDT(n=42)and CDT alone(n=36),followed by endovascular angioplasty based on vascular stenosis.The perioperative adverse events(new pulmonary embolism(PE),subcutaneous hemorrhage,and puncture point hematoma)were reported in the two groups,including the changes in peripheral limb diameter,thrombolysis time,urokinase dosage,thrombus clearance rate,and the incidence of perioperative adverse events(new pulmonary embolism(PE),subcutaneous hemorrhage,and puncture point hematoma).After discharge,the patients were followed up for up to one year by a specialist.The ultrasound of lower extremity vessels was reviewed at the outpatient department at 1 month,3 months,6 months and 12 months after discharge,respectively,to examine and evaluate the patients' vein patency and the occurrence of medium and long-term complications.Results The thrombolytic time of PMT combined with CDT group and CDT group alone was(3.29±1.92)d and(5.47±2.06)d,respectively,and the dosage of urokinase was(189.05±138.31)and(288.75±129.32).The thrombolytic time and dosage of urokinase in the two groups were significantly different(P<0.001,P=0.002).PMT combined with CDT group? level,?,? thrombus clearance rate was 16.7%(7/42),71.4%(30/42),11.9%(5/42);CDT group alone ?,?,? thrombus clearance rate was 25.0%(9/36),63.9%(23/36),11.1%(4/36),compare two groups of patients with each grade thrombus clearance,there was no significant difference(P= 0.607).After 48 hours of thrombolytic therapy,the peri-thigh diameter difference(2.10±0.99)cm and peri-calf diameter difference(1.28±1.07)of the affected side in the PMT combined with CDT group.In the CDT group alone,the change of peripheral diameter of the affected side of the thigh was(1.28±1.07)cm and that of the affected side of the calf was(0.83±0.56)cm.48 h after the operation,there was a significant difference between the two groups in the change value of circumference diameter of large and small legs(P=0.001,P=0.008).The total number of perioperative adverse events was 3(7.1%)in the PMT combined with CDT group and 3(8.3%)in the CDT group alone,with no statistically significant difference(P=0.697).PMT combined with CDT group,pure CDT group alone patients discharged from hospital after 3 months of I,II,class II vascular patency rate respectively(9.5%,47.6%,42.9%)vs(16.7%,44.4%,38.9%),6 months I,II,class II vascular patency rate was(5.7%?20.0%?74.3%)vs(9.7%,19.3%,71.0%),for 12 months(3.0%,9.1%,87.9%)vs(6.9%,13.8%,79.3%),There was no significant difference in the vascular patency rate at 3,6 and 12 months between the two groups(P=0.641,P=0.917,P=0.659).Patients in the two groups were followed up for 12 months.The 6-month follow-up rate of the PMT combined with CDT group was 83.3%(35/42),and that of the CDT group alone was 86.1%(31/36).During the follow-up for 6 months,3 patients in the PMT combined with CDT group(8.6%)and 3 patients in the CDT group alone(9.7%)had fresh thrombi recurrence,with no significant difference(P=0.603).The 12-month follow-up rates of PMT combined with CDT group and CDT group were 78.6%(33/42)and 80.6%(29/36),respectively.During the period,3 patients in the PMT combined with CDT group had mild PTS,3 patients in the CDT group had mild PTS,and 1 patient had moderate PTS.There was no significant difference between the two groups(P=0.696).According to the villalta score evaluation,the villalta score of patients in the PMT combined with CDT group and the CDT group alone at 6 months was(2.43±2.16)vs(2.58±2.94),and the villalta score at 12 months was(2.67±1.86)vs(3.17±2.79),and there was no significant difference in the villalta score between the two groups at 6 months and 12 months(P=0.780,P=0.349).Conclusions Compared with CDT alone,PMT combined with CDT can significantly reduce the injection dose of urokinase,shorten the duration of thrombolysis,and have the advantage of alleviating the swelling of affected limb in a short time.The two treatments were similar in clinical efficacy,with no significant differences in thrombosis clearance rate,medium and long-term venous patency,perioperative adverse events,and medium and long-term complication rates.