Application Of Two Thrombus Removal Methods In The Treatment Of Lower Extremity Deep Vein Thrombosis In Different Stages And Locations: A Single-center Case Study

Objective: To summarize the application effect of mechanical thrombectomy and catheter thrombolysis in the treatment of lower extremity deep vein thrombosis in different stages and locations in our center.Methods: In this study,patients with DVT in different parts of the lower extremities in the acute and subacute stages who visited our center from January 2017 to October 2021 and were diagnosed by vascular Doppler ultrasonography or venography were collected retrospectively.For PMT group(n=106 cases)and CDT group(n=108 cases).In the PMT group,there were 31 cases of acute central DVT,14 cases of acute mixed DVT,14 cases of acute partial peripheral DVT,18 cases of subacute central DVT,13 cases of subacute mixed type,and 10 cases of subacute partial peripheral DVT.In the CDT group,there were 29 cases of acute central DVT,21 cases of acute mixed DVT,17 cases of acute partial peripheral DVT,19 cases of subacute central DVT,10 cases of subacute mixed type,and 12 cases of subacute partial peripheral DVT.Collect general data of patients(gender,age,body mass index(BMI),left and right sides of the affected limb,duration of disease,whether there is tumor,whether there is trauma,whether there is long-term bed rest,whether there is pregnancy,whether there is blood hypercoagulability status,etc.),clinical data(the difference between the thigh circumference of the affected limb and the healthy limb,whether there is pain,whether there is swelling,whether there is pulmonary embolism,and the time of onset,etc.),surgical data(operation method,whether there is stent implantation,thrombus accumulation scope,degree of vascular embolism,etc.),perioperative data(with or without hematuria,with or without hemoglobinuria,with or without pulmonary embolism,with or without acute renal failure,with or without bleeding signs,length of hospital stay,total hospitalization expenses,etc.).All patients had no previous surgical treatment,and were diagnosed as lower extremity DVT by intravenous ultrasonography or digital subtraction angiography in our hospital.Results: In acute central DVT,acute mixed DVT,acute partial peripheral DVT,subacute central DVT,subacute mixed DVT,and subacute partial peripheral DVT,there was no statistical significance in the clinical baseline data between the CDT group and the PMT group(P>0.05).The thigh circumference difference,thrombus score and thrombus clearance rate in the acute mixed DVT group treated with CDT were significantly better than those in the acute mixed DVT group treated with PMT(P=0.03);the subgroup treated with PMT The thigh circumference difference,thrombus score and thrombus clearance rate in the acute central DVT group were significantly better than those in the subacute central DVT group treated with CDT,and the difference was statistically significant(P=0.04).The days of hospitalization in each subgroup treated with CDT were significantly higher than those in each subgroup treated with PMT(P<0.05),but the opposite was true for hospitalization expenses(P<0.05).At 12 months after discharge,the incidence of PTS in the subacute mixed DVT group undergoing PMT was significantly lower than that in the subacute mixed DVT group undergoing CDT,and the difference was statistically significant(P=0.04).The quality of life of the subacute central DVT group undergoing PMT was significantly better than that of the subacute central DVT group undergoing CDT 12 months after discharge(P=0.03).In the follow-up of anticoagulant drug use and compression treatment at 3 months,6months and 12 months after discharge,there was no significant difference in each subtype of DVT between CDT group and PMT group(P>0.05),and anticoagulant The use of coagulation drugs and the proportion of compression therapy continued to decline.Conclusion: Both PMT and CDT have good effects on lower extremity DVT in the acute and subacute stages,can quickly remove thrombus,open the blocked lumen,significantly improve clinical symptoms,and are safe and reliable;for acute mixed DVT,CDT can be selected to treat Rapid thrombus removal;for subacute central DVT,PMT can be selected to remove thrombus and improve clinical efficacy.Compared with CDT,PMT can reduce the incidence of long-term PTS in subacute mixed DVT.