| Object: To investigate the efficacy and safety of balloon-assisted catheter directedthrombolysis (CDT) for acute lower extremity deep vein thrombosis (LEDVT).Method: A retrospective analysis was carried out in152patients with acute LEDVTadmitted to our department from November2006to March2011. According to thedifferent methods, the152patients were divided into three groups: group A (n=58): systemthrombolysis through the dorsal vein of foot; group B (n=50): treated by CDT; group C(n=44): treated by balloon-assisted CDT. The circumference difference between normaland affected limbs, score of venous patency, and the rate of venous patency and the rate ofPostthrombosis Syndrome (PTS) were applied to judge the efficacy. The safety oftreatment was evaluated according to the incidence of pulmonary embolism and bleeding.The total dose of urokinase, the thrombolysis time and the variation of coagulation indexeswere compared in the three groups. All data was treated with SPSS18.0statistical package.Result:①The prior treatment circumference difference between normal and affectedlimbs: Group A5.32±1.92cm (thigh),4.18±1.47cm (calf); Group B5.41±2.12cm (thigh),4.15±1.41cm (calf); Group C5.87±2.42cm (thigh),4.17±1.38cm (calf)，the differencebetween each group was insignificant (thigh: P>0.05; calf: P>0.05). The post treatmentcorrespondence: Group A2.86±1.12cm (thigh),1.95±0.84cm (calf); Group B2.18±1.40cm (thigh),1.08±0.47cm (calf); Group C0.89±0.57cm (thigh),0.68±0.46cm(calf)，with significant differences((thigh: P<0.05; calf: P<0.05). The circumferencedifference between normal and affected limbs of Group C was much smaller than those ofGroup A and Group B, all have significant differences (thigh: P<0.05; calf: P<0.05).②The prior treatment score of venous patency: Group A9.08±1.38, Group B9.23±1.33；Group C9.78±1.45, without significant difference (P>0.05). The post treatment score ofvenous patency: Group A5.17±1.24, Group B3.68±0.98；Group C1.02±0.43, with significant difference(P<0.05). The score of venous patency of Group C was much smallerthan those of Group A and Group B, has significant difference (P<0.05).③The rate ofvenous patency just after the treatment: Group A24.0%, Group B67%, Group C98%,the rate of venous patency of Group C was much higher than that of Group A and Group B,has significant difference(P<0.05).④The rate of Puncture site bleeding: Group A6.9(4/58)%, Group B22（11/50）%；Group C8.2（8/44）%, the rate of puncture site bleedingof Group A was lower than those of Group B and Group C, has significantdifference(P<0.05), the rate of bleeding of Group B and Group C has insignificantdifference (P>0.05).⑤The rate of pulmonary embolism: Group A6.9(4/58)%, Group Bnone；Group C none, the rate of pulmonary embolism of Group A was higher than Group Band Group C, has significant difference(P<0.05).⑥The total dose of urokinase: GroupA:6.20±2.80×106U, Group B:6.40±1.39×106U, Group C:4.20±1.40×106U, the totaldose of urokinase of Group C was much less than those of Group A and Group B, hassignificant difference(P<0.05).⑦The time of thrombolysis: Group A:10.5±2.8d,GroupB:9.5±2.5d,Group C:4.0±1.2d, the thrombolysis time of Group C was much shorter thanthose of Group A and Group B, has significant difference(P<0.05).⑧Before and after thetreatment, the coagulation indexes all have insignificant difference(P>0.05).⑨Follow up:the rate of venous patency after discharge6month: Group A：18%, Group B：63%, GroupC：94%, the rate of venous patency of Group C was much higher than those of Group Aand Group B, has significant difference(P<0.05). The rate of PTS recurrence at the lastfollow-up point: Group A:51%, Group B38%, Group C11%, Group C was much lowerthan that of Group A and Group B, has significant difference (P<0.05).Conclusion: Balloon-assisted CDT was a promising treatment for acutelower-extremity DVT. It could improve lysis effect, reduce thrombolysis time and dosage ofurokinase, reduce the rate of PTS recurrence and does not increase the risk of pulmonaryembolism. |
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