| Objective: To investigate the efficacy and safety of catheter-directed thrombolysis in the simultaneous treatment of intermediate-risk pulmonary embolism complicated with acute deep venous thrombolysis.Methods: A total of 36 patients with intermediate-risk pulmonary embolism complicated with central or mixed deep vein thrombolysis were selected as the study subjects from January 2015 to December 2019 in The Affiliated Hospital of Qingdao University.All patients were treated with catheter-directed thrombolysis to the pulmonary artery and deep vein of the lower extremity simultaneously through femoral vein approach under the protection of inferior vena cava filter.The position of catheter was adjusted or extubation according to the angiographic results after re-examination every 2-3 days.Endovascular therapy was performed for patients with iliac vein compression syndrome after thrombolysis.The thrombolytic effect of pulmonary embolism and deep venous thrombosis and the occurrence of adverse events during treatment were recorded,and the changes of coagulation indexes during treatment were monitored.The occurrence of post thrombotic syndrome and recurrence of thrombosis were recorded during 2 years of follow-up.Results: 1.All patients were successfully treated with catheter-directed thrombolysis,and the success rate of surgery was 100%.The extraction rate of inferior vena cava filter was 94.4%(34/36).Iliac vein compression syndrome was present in 6 patients,and iliac vein stent implantation was performed in 5 patients.2.After catheter-directed thrombolysis,the clinical symptoms of the patients were improved,respiratory rate and peripheral capillary oxygen saturation were significantly improved(P<0.05).Echocardiography showed that pulmonary artery systolic pressure decreased from(58.56±16.25)mm Hg preoperatively to(32.42±10.83)mm Hg postoperatively.The thrombus was effectively cleaned after thrombolysis.Miller score decreased from(22.28±7.73)points before operation to(1.97±0.44)points after operation (P<0.05),and venous patency score decreased from(5.08±2.87)points before operation to(1.11±1.28)points after operation(P<0.05).The thrombolysis rate of lower limbs was(80.91±19.59)%.The trend change diagram of D-dimer and fibrinogen during thrombolytic period showed that D-dimer reached the peak value on the second day of thrombolytic period,then gradually decreased and finally stabilized,and fibrinogen showed a continuous downward trend.3.During the treatment,there were 2 cases of puncture site bleeding and 1 case of gingival bleeding,and the symptoms were improved after active treatment.No other adverse events were observed.4.After 5 months of follow-up,1 patient died of malignant tumor.At 24 months of follow-up,3 patients had mild to moderate post thrombosis syndrome,and 5 patients had recurrent thrombosis.After 2 years of follow-up,5 patients had recurrent thrombosis,including 1 case of iliac vein stent thrombosis.Conclusion: 1.Under the protection of the inferior vena cava filter,the use of catheter-directed thrombolysis to remove thrombosis in patients with pulmonary embolism can relieve clinical symptoms in a short term,improve patients’ cardiopulmonary function,with fewer complications,good safety.2.Simultaneous catheter-directed thrombolysis for pulmonary embolism and deep vein thrombosis can improve the thrombus clearance rate within a limited time window and reduce the incidence of long-term complications.3.For patients with iliac vein compression syndrome found in the course of treatment,combined intravascular therapy can correct the anatomical factors of iliac vein stenosis,improve venous blood reflux of lower limbs,and reduce the probability of thrombosis recurrence,with ideal clinical effect. |
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