The Clinical Study Of The Pharmacomechanical Thrombectomy For The Lower-extremity Occlusion Disease

There are two parts in our study.Part 1.The Clinical Study of the AngioJet Rheolytic Thrombectomy for the Acute Lower Extremity Deep Vein ThrombosisObjective:To investigate the efficacy of AngioJet Rheolytic Thrombectomy in the treatment of acute lower extremity deep vein thrombosis(LEDVT)with additional infusion of thrombolytic agents during the procedure.Methods:A total of 64 patients who underwent the AngioJet Rheolytic Thrombectomy for LEDVT were included in the study.Patients were divided into 2treatment groups:with additional infusion of thrombolytic agents in 26 patients or without in 38 during the procedure respectively.Adjunctive thrombolysis was used in all patients.Comparisons were made with regards to the treatment outcome between the two groups.Results:In the two groups,the swelling regression rate were(85.13±14.63)%and(78.44±19.09)%,the venous patency rate after the AngioJet Rheolytic Thrombectomy were(73.78±5.62)%and(73.21±6.21)%,the venous patency rate after the treatment were(98.81±4.23)%and(95.28±8.84)%,the total thrombolytic agent dose were(162.69±103.75)*10~4U and(157.55±57.20)*10~4U,the thrombolytic infusion time were(85.46±67.05)h and(77.03±44.29)h,the mean activation time of the thrombectomy device were(244.42±87.07)s and(212.74±77.13)s.There were no statistical difference in the above indexes between the two groups(p=0.686,p=0.861,p=0.081,p=0.711,p=0.945 and p=0.208 respectively).A slight transient hemoglobinuria was noticed in 10 patients(38.5%)and 13 patients(34.2%)respectively,and the differences between them was not statistically significant(?2=0.12 p>0.05).Conclusion:The AngioJet Rheolytic Thrombectomy in the treatment of LEDVT with or without additional infusion of thrombolytic agents during the procedure has the similar short-term efficacy,and the long-term efficacy needs to be studied further.Part 2.Application of the AngioJet Rheolytic Thrombectomy in the treatment of the Acute Limb IschemiaObjective:To investigate the availability and safety of the AngioJet Rheolytic Thrombectomy in the treatment of the acute limb ischemia(ALI).Methods:A total of 27 patients presenting with ALI undergoing treatment with the AngioJet Rheolytic Thrombectomy were available for retrospective analysis.Outcomes were assessed including initial angiographic success,pre-and postprocedural ankle-brachial index(ABI),device-related and systemic complications,amputation and mortality.Results:The technical success rate was 100%.The thrombus clearances after initial treatment in all patients were greater more than 50%,among them 10 patients(37.0%)reached to grade III and 17 patients(63.0%)grade II.The mean ankle-brachial index increased significantly from 0.41±0.07 to 0.88±0.12 after intervention(p<0.001).The clinical symptoms were relieved in all patients.In five patients,a slight transient hemoglobinuria was noticed.No patients of serious complications such as cerebral hemorrhage,kidney damage and death were observed.Acute limb salvage,6-month limb salvage and 1-year limb salvage was achieved in 25 of 27 limbs(92.6%),12 of 15 limbs(80%),10 of 13 limbs(76.9%),respectively.Conclusion:The AngioJet Rheolytic Thrombectomy appears to be safe and effective for the treatment of the ALI.It offers great advantage to rapidly reestablish blood flow to an ischemic extremity and may be the alternative treatment option in patients who is at high risk for open surgery or with contraindications to pharmacologic thrombolysis.