The Research To Curative Effects And Complications With Drug And Endovascular Therapy Of Lower Extremity Deep Vein Thrombosis

Objective: To investigate the clinical effects and security of anticoagulation and endovascular therapy for acute Iliac-emoral venous thrombosis.Methods: From January 2015 to September 2016 in our research center,142 patients definitely diagnosed with acute I-FVT by vascular color Doppler Ultrasound and met the inclusion criteria were taken as the research.Respectively had taken drug anticoagulant therapy alone or percutaneous endovascular therapy which included catheter directed thrombolysis(CDT),percutaneous mechanical thrombus removal(PMT)and PMT combining with CDT.All of the patients were measured the perimeter of both lower limbs and examined vascular color Doppler Ultrasound before hospitalization and discharge.3 months,6 months and12 months after treatment were followed-up.Through the statistics and analysis cure rate,effective rate and the degree of vein patency.Incidence rate of the adverse events(new PE,subcutaneous hemorrhage,hematoma at puncture position)during treatment and recurrence rate of DVT,the incidence of PTS and severity level in follow-up period.Evaluate the effectiveness and security of the different treatments for acute I-FVT patients.Results:1.Endovascular therapy group and anticoagulation group:The cure rate(above knee: 58.8% vs 12.5%,below knee: 53.9% vs 10%),the effective rate(above knee: 96.1% vs 65%,below knee: 97.1% vs 75%),the difference was statistically significant(P<0.001);The degree of vein patency: III(18.6% vs 5.0%),II(7.5% vs 22.5%),I(3.9% vs 72.5%),with significant difference(P<0.001);The cure rate,the effective rate,and degree of vein patency of endovascular therapy group was better than anticoagulation group.There was no significant difference between the two groups in the incidence rate of PE and subcutaneous hemorrhage during treatment(P>0.05);however,the adverse events such as hematoma at the puncture site,hemoglobinuria,contrast agent nephropathy,secondary thrombosis and the incidence rate in endovascular therapy group were higher than those in anticoagulant group.During the follow-up period,the degree of vein patency in endovascular group was better than that of the anticoagulant group in 3 months,with the difference was significant(P<0.001);In 6 months,the recurrence rate of DVT(7.8% vs 22.5%)and the incidence of PTS(15.7% vs 37.5%),both the recurrence rate of DVT and the incidence of PTS of endovascular therapy group were lower than those in anticoagulant group,with the difference was statistically significant(P<0.05);The scores of Villalta with PTS in endovascular therapy group were lower than that of anticoagulant group in 6 months and12 months,and the difference between the two groups was statistically significant(P<0.05).2.Endovascular therapy among the three groups: There was no significant difference in cure rate,effective rate and the degree of venous patency(P>0.05).That is,there was no significant difference among the three kinds of endovascular therapy in the treatment of acute I-FVT.The incidence rate of new PE,subcutaneous hemorrhage and hematoma with puncture sitewere have no significant difference among the three kinds of endovascular therapy during treatment(P>0.05).The incidence of hemoglobinuria in PMT and PMT+CDTgroup(23.3% vs 19.4%)were no significant difference(P>0.05).Both PMT and PMT+CDT group compared with CDT group,the difference was statistically significant(P<0.05).There was no significant difference among the three groups during the follow-up period in 3 months(P>0.05).In 6 months,the recurrence rate of DVT and the incidence of PTS were no significant difference among the three groups.Also,the scores of Villalta in the three groups was no significant difference in 6 months and 12months(P>0.05).Conclusions:1.Endovascular therapy for acute I-FVT in the short term and mid term efficacy was better than drug anticoagulation treatment,but had a greater incidence of adverse events during treatment period.2.There was no significant difference in the short term and mid term efficacy among the three kinds of endovascular therapy,the incidence of adverse events were no significant difference during treatment period and follow-up period.