Systematic Evaluation Of The Clinical Effect And Safety Of Manual Apiration Thrombectomy Combined With Catheter-directed Thrombolysis And Catheter-directed Thrombolysis In The Treatment Of Acute Lower Extremity Proximal Deep Venous Thrombosis

Objective: To systematically evaluate the clinical efficacy and safety of large-cavity catheter manual aspiration thrombectomy(MAT)combined with catheter-directed thrombolysis(CDT)and simple catheter-directed thrombolysis(CDT)in the treatment of acute lower extremity proximal deep venous thrombosis.Methods: Use "Deep Venous Thrombosis","Manual aspiration thrombectomy","Percutaneous aspiration thrombectomy","catheter-directed thrombectomy" as keywords to search PubMed,EMBASE,OVID,KARGER,Accessmedicine,Medline and other foreign language databases.The Chinese databases such as How Net,Weipu Journal,Wanfang,and China Biomedical Literature Service System were searched using the keywords "lower extremity deep venous thrombosis","manual suction thrombosis",and "tube thrombolysis".The search time limit is from the establishment of the database to March 2020.Two literature reviewers with relevant training independently conducted article quality evaluation,including the preliminary screening of the literature and the extraction of related data.The last two literature reviewers cross-checked to ensure the consistency of data extraction.The meta-analysis of the included studies was conducted with Review Manager 5.1statistical software.Results: A total of 7 articles were selected,including 1 RCT study and 6 retrospective case-control studies.Meta analysis results showed that the treatment time of MAT combined with CDT was shorter than that of CDT alone(SMD =-1.90,95% CI:-2.39～-1.42,P <0.00001).MAT combined with CDT was better than CDT alone(OR =2.31,95% CI: 1.32 ～ 4.05,P = 0.003).The combined application of MAT and CDT urokinase was less than that of CDT alone(SMD =-1.23,95% CI:-1.46 ～-1.00,P<0.00001).The bleeding complications after MAT combined with CDT were less than CDT(OR = 0.18,95% CI: 0.08 ～ 0.40,P <0.001).The incidence of edema was less than CDT one year after MAT combined with CDT was discharged(OR = 0.40,95%CI: 0.24 ～ 1.47,P = 0.01).The incidence of hyperpigmentation after MAT combined with CDT was less than CDT one year after discharge(OR = 0.11,95% CI: 0.02 ～0.63,P = 0.01).The incidence of PTS was less than that of CDT two years after discharge from MAT combined with CDT(OR = 0.30,95% CI: 0.13 ～ 0.68,P =0.004).Conclusion: The combined use of manual aspiration thrombectomy and catheter-directed thrombolysis has higher clinical efficacy and safety for acute lower extremity proximal deep venous thrombosis than catheter-directed thrombolysis alone.The combined use of manual aspiration thrombectomy and catheter-directed thrombolysis significantly improved the thrombectomy rate,treatment time and urokinase usage,which in turn significantly reduced the incidence of postoperative bleeding complications.It can be seen that the incidence of complications such as edema and pigmentation one year after surgery and the incidence of PTS two years after surgery are significantly reduced.Overall,large-cavity catheter manual aspiration thrombectomy(MAT)combined with catheter-directed thrombolysis(CDT)should be a safe and therapeutic method with better curative effect.