Clinical Efficacy Of Aspirex Endovascular Thrombectomy Combined With Catheter-Directed Thrombolysis In The Treatment Of Lower Extremity Deep Vein Thrombosis

BackgroundPulmonary embolism（PE）and deep venous thrombosis（DVT）are two manifestations of venous thromboembolism（VTE）in different stages.VTE is currently the third largest cardiovascular death event in the Western world after cerebral embolism and myocardial infarction.Although the early impression is that the incidence of VTE in Asian populations is lower than that in Western populations,studies have shown that Asian VTE patients are more likely to have PE,and have a higher mortality rate^[1].A recent epidemiological survey on VTE in my country pointed out that in the 10 years from 2007 to 2016,the hospitalization rate of VTE patients increased from 3.2/100,000 to 17.5/100,000,but the mortality rate decreased from 4.7%to 2.1%^[2].If we take the huge population of our country and the lack of awareness of VTE among the public and even medical staff into account^[3],the burden caused by VTE is still huge.Stop the spread of the thrombus,reduce the occurrence of symptomatic PE,provide rapid relief of symptoms,and reduce the occurrence of post-thrombotic syndrome（PTS）are the goals of DVT treatment.Anticoagulation therapy is the basic method for DVT,but it does not have the function of dissolving the formed thrombus,it is not ideal for the removal of thrombus burden and the relief of clinical symptoms.Even after standard anticoagulation,nearly 30%of patients with lower extremity DVT will experience recurrence within 10 years^[4],and up to 50%will develop PTS of varying degrees within 2 years^[5].Phlebotomy thrombectomy and systemic thrombolysis are less used because of the large trauma,many related complications,and high residual thrombus rate.Catheter-directed thrombolysis（CDT）is the standard therapy recommended by various guidelines currently^[6][7],with definite curative effect and relatively few complications.But with the advent of the Percutaneous mechanical thrombectomy（PMT）device,there has been an ongoing debate about the superiority of the two surgical approaches.Several studies^[8,9]have shown that the combination of PMT and CDT can achieve better results than the two alone.In this study,the combined use of Straub Aspirex mechanical thrombectomy device（PMT）and catheter-contact thrombolytic therapy（CDT）compared with simple catheter-based thrombolysis（CDT）to verify the efficacy and safety of PMT+CDT,and based on the treatment process related issues that arise in it.PurposeTo assess the efficacy and safety outcomes of percutaneous mechanical thrombectomy（PMT）using Straub Aspirex combined with catheter-directed thrombolysis（CDT）in the treatment of lower extremity deep vein thrombosis（LEDVT）,compared with CDT alone.Materials and methodsRetrospective review of the clinical data of 72 cases with LEDVT in the Department of Vascular Surgery from 2019.01 to 2021.08,the First Affiliated Hospital of Zhengzhou University,which included 36cases in the PMT+CDT group,and 36 cases in the simple CDT group.The differences in the relief of limb swelling after treatment,thrombus clearance rate,complications,urokinase（UK）dose,hospital stay and costs,and the Villalta score during follow-up were recorded and compared in the two groups.P<0.05 was considered statistically significant.Result1.All patients in the pure CDT group were successfully catheterized,and the thrombus clearance rate reached grade Ⅲ in 1 case,grade Ⅱclearance in 33 cases,and grade Ⅰ clearance in 2 cases,with a clinical success rate of 94.44%;all patients in the PMT+CDT group underwent thrombus removal and The indwelling thrombolytic catheter was successful,and the thrombus clearance rate reached grade Ⅲ in 10 cases,grade Ⅱ clearance in 26 cases,and grade Ⅰ clearance in 0 cases,with a clinical success rate of 100%.There was no statistical difference in the clinical success rate between the two groups[34 cases（94.44%）vs.36 cases（100%）P=0.151].2.Postoperative PMT+CDT group had higher thrombus clearance rate than CDT group[83.1（75.0-97.5）%vs.65.0（56.0-75.0）%]and higher thigh swelling rate（63.5±18.8%vs.37.2±20.3%）and lower leg swelling rate[64.8（46.6-75.0）%vs.44.5（25.0-66.7）)%],the difference was statistically significant（P<0.05）.No major bleeding or symptomatic PE occurred in the two groups during hospitalization,but 1 case and 4 cases of puncture point hematoma occurred in the PMT+CDT group and the pure CDT group,respectively,and the difference was not statistically significant（P=0.163）.3.Compared with the simple CDT group,the PMT+CDT group had a lower dosage of urokinase[（312.4±237.2）×104U vs.（544.9±189.6）×104U,P<0.001],and a shorter hospital stay[13.0（11.0]-15.0）days vs.15.7（12.3-18.0）days,P=0.01].However,the hospitalization cost in the PMT+CDT group was higher[98592.0（79444.0-111945.5）Yuan vs.66792.7（60263.9-78678.2）Yuan,P<0.001].4.During the average follow-up period of 12.1（9-14）months,there were 2 cases and 7 cases of post-thrombotic syndrome（PTS）in the PMT+CDT group and the pure CDT group,respectively,and the difference was not statistically significant（P=0.075）.,but the final Villalta score in the PMT+CDT group was lower than that in the CDT group[1.55（0.5-2.0）points vs.3.09（1.5-4.0）points,P=0.01].There was no thrombus recurrence during the follow-up period in the PMT+CDT group,while 5 cases of thrombus recurrence occurred in the CDT group alone,and the difference was statistically significant[0%vs.13.9%,P=0.02].ConclusionStraub Aspirex thrombus combined with CDT and CDT alone have good safety and effectiveness.Compared with group CDT,group PMT+CDT has higher limb swelling rate and thrombus clearance rate,less hospitalization time and UK does.In the long term,there is no significant difference in the incidence of PTS between the two groups,but the severity of PTS in group PMT+CDT is less than that in group CDT,and group PMT+CDT has better performance in preventing thrombosis recurrence than group CDT.