Clinical Effect Of "One-stop" Treatment For Acute Left Lower Extremity Deep Venous Thrombosis With Iliac Vein Compression Syndrome

Purpose:To evaluate the safety and efficacy of "one-stop" treatment for acute left lower extremity deep vein thrombosis(DVT)combined with iliac vein compression syndrome(IVCS).Methods:67 patients with acute left lower extremity DVT combined with IVCS were included in our study.The patients were hospitalized in Department of Vascular Surgery,Affiliated Hospital of Jining Medical University between January 2015 and January 2018.The patients were divided into two groups according the treatment options.Group A contains 33 patients receiving "one-stop" treatment,a serial combination of inferior vena cava filter implantation,catheter contact thrombolysis(CDT),iliac vein balloon dilatation(PTA)+ stent implantation,and inferior vena cava filter removal during one hospital stay.Group B was comprised of 34 patients undergoing staged surgery.Patients in group B were treated with inferior vena cava filter implantation and CDT for their DVT during the first-time hospital stay.Then anticoagulant therapy was performed after they leave hospital with symptoms improved.Two weeks later,the inferior vena cava filter was removed,iliac vein PTA + stent implantation or simple iliac vein PTA was performed simultaneously orelectively depending on the patient's options.Clinical data of the 67 patients were collected and retrospectively analyzed,including the onset time,D-dimer level,limb circumference pre-and post-treatment venous patency score,thrombolytic treatment time,complications,recurrent thrombosis,thrombosis in filter,occurrence of post-deep thrombotic syndrome(PTS),time,frequency costs of hospitalizations,to compare the efficacy and safety of the two treatments.Results:There was no significant difference in gender,age,disease duration,and other indicators pre-treatment of the patients between Group A and B.Both treatment methods were effective in relieving symptoms and improving venous patency of the patients.There was a significant difference in the thigh circumference,calf circumference,and venous patency scores of patients in group A or B before and after treatment(P < 0.001).The difference value of thigh circumference,calf circumference,and venous patency pre-and post-treatment was calculated and compared between the Group A and Group B.There was no significant difference between the two groups(P > 0.05).The recurrence rate of thrombosis in group A was significantly lower than that in group B(P = 0.042),and the times of punctures in group A was significantly less than that in group B(P = 0.006),while there is no significant difference t in thrombolysis time between the two groups(P = 0.396).There was no significant difference in recurrence rate of complications,like bleeding andpulmonary embolism,during hospitalization between group A and B(P = 0.756 and P = 0.306,respectively),and no thrombus was seen in all patients.The times or during time of hospital stays in group A was significantly less than that in group B(P < 0.001),but there was no significant difference in total hospitalization costs between the two groups(P = 0.71).Conclusions:The “one-stop” procedure is effective in treating acute DVT with IVCS.Compared with staged surgery,the "one-stop" protocol can achieve the same effect without increasing medical costs and occurrence of complications such as bleeding and pulmonary embolism,and reduce puncture injury and recurrence of thrombus during treatment.The "one-stop" protocol is better for prevention of long-term complications than staging surgery,and could also shorten hospital stays and reduce the times of hospitalizations.