Clinical Value Study Of AngioJet Percutaneous Mechanical Thrombectomy Combined With Catheter-directed Thrombolysis In The Treatment Of Lower Extremity Deep Venous Thrombosis Complicated With Iliac Vein Compression Syndrome

Objective:To evaluate the clinical value of AngioJet percutaneous mechanical thrombectomy(PMT)combined with catheter-directed thrombolysis(CDT)in the treatment of lower extremity deep venous thrombosis(LEDVT)with iliac vein compression syndrome(IVCS).Methods:The clinical data of 158 patients with lower extremity deep venous thrombosis complicated with iliac vein compression syndrome admitted to the Department of Vascular Surgery,Kunshan Hospital Affiliated to Jiangsu University from May 2019 to May 2021 were retrospectively analyzed.Among them,98 patients underwent catheter-directed thrombolysis alone(CDT group),and 60 patients underwent AngioJet percutaneous mechanical thrombectomy combined with catheterdirected thrombolysis(PMT group).The efficacy of the two groups of patients was compared,including clinical symptom relief,thrombus clearance rate,limb swelling rate,operation time,thrombolysis time,urokinase dosage,hospitalization time,postthrombotic syndrome(PTS),thrombosis recurrence,stent stenosis and other indicators;and safety,including red blood cell loss,liver dysfunction,renal insufficiency,bleeding,death,pulmonary embolism and other indicators.Results:In terms of efficacy,there was no significant difference in venous clinical severity score(VCSS)of symptoms and signs between the two groups at 7 days after operation(P > 0.05),which was significantly improved compared with that before operation(P < 0.05).On the first day after operation,the thrombus clearance effect of PMT group was significantly better than that of CDT group [0.71(0.66,0.75)vs 0.38(0.30,0.44),P < 0.001],but on the fifth day after operation,the thrombus clearance effect of the two groups was similar(P = 0.140).On the third day after operation,the detumescence effect of the lower leg and thigh in the PMT group was significantly better than that in the CDT group [0.81(0.76,0.85)vs 0.60(0.50,0.65),P < 0.001],[0.71(0.68,0.73)vs 0.56(0.52,0.60),P < 0.001].The operation time and hospitalization expenses in the PMT group were significantly higher than those in the CDT group [(82.48 ± 6.15)h vs(70.39 ± 7.05)h,(114263.05 ± 10546.73)yuan vs(85977.51 ± 8043.85)yuan](all P < 0.001);in terms of thrombolysis time,urokinase dosage and hospitalization time,the PMT group was significantly better than the CDT group [(93.65 ± 10.41)h vs(155.09 ± 23.57)h,(770.0 ± 179.7)thousand U vs(1489.8± 318.1)thousand U,(8.65 ± 1.12)days vs(11.84 ± 1.91)days](all P < 0.001).After18 months of follow-up,there was no significant difference in the incidence of PTS,thrombosis recurrence and stent restenosis between the PMT group and the CDT group(28.33 % vs 31.63 %,11.67 % vs 11.22 %,8.33 % vs 10.20 %)(all P > 0.05).In terms of safety,the red blood cells(RBC),hemoglobin(Hb),serum creatinine(Scr),blood urea nitrogen(BUN)of patients in CDT group on the first and fifth days after operation were not significantly different from those before operation(P > 0.05),but alanine aminotransferase and aspartate aminotransferase were significantly higher than those before operation(P < 0.001).In the PMT group,RBC and Hb on the 1 st and 5 th day after operation were significantly lower than those before operation(P < 0.001),and Scr,BUN,ALT and AST were significantly higher than those before operation(P <0.001).There was no significant difference in the incidence of urinary tract bleeding,gastrointestinal bleeding,puncture point bleeding and subcutaneous ecchymosis between the two groups(P > 0.05).No puncture site hematoma,pulmonary embolism and death occurred in both groups.Conclusion:AngioJet percutaneous mechanical thrombectomy combined with CDT has good efficacy in the treatment of LEDVT with May-Thurner syndrome in the short term.It can quickly and effectively remove thrombus and effectively improve the symptoms of lower limb swelling and pain.The thrombolysis time,thrombolysis dose and hospitalization time of the patients were reduced.However,there are risks of anemia and acute kidney injury(AKI)after AngioJet mechanical thrombectomy.In general,the benefit of patients is high,which reduces the burden of patients and medical treatment.It is worthy of clinical application and promotion.