The Clinical Study Of Comprehensive Interventional Treatment For Acute Left Deep Vein Thrombosis Combined With Cockett Syndrome

Part 1 Acute Deep Vein Thrombosis of Left Lower Extremity Secondary to Severe Iliac Vein Stenosis:When to Implant the Stent.Objective:To investigate the effects of different implantation times of iliac vein stent on thrombolytic therapy for acute deep venous thrombosis(DVT)of left lower extremity secondary to severe iliac vein stenosis.Methods:Retrospectively analyzed the clinical data of 44 patients suffered from acute DVT of left lower extremity secondary to severe iliac vein stenosis who were admitted to our department from January 2014 to May 2017.Patients with iliac vein stent implantation performed before catheter-directed thrombolysis(CDT)were enrolled in group A(n=18)while the rest of the patients whose stent implanted after CDT employed in group B(n=26).The swelling regression rate,thrombus removal rate,total doses of urokinase,thrombolytic time,hospitalization costs and occurrence of complications,were statistically compared between two groups.Result:The swelling regression rate above the knee was(70.63±20.02)%in group A and(68.87±32.35)%in group B.The swelling regression rate below the knee was(63.28±20.34)%in group A and(69.53±22.50)%in group B.Thrombus removal rate in the two groups were(91.32±15.09)%and(96.00±4.67)%respectively.These differences were not statistically significant(all P>0.05).While,in group A and group B,the total doses of urokinase were(170.00±73.32)×10~4U and(240.00±114.82)×10~4U respectively,the thrombolysis days were(2.97±1.50)days and(4.77±3.09)days respectively,the hospital cost were(47423.40±12952.78)yuan and(55998.44±7094.25)yuan respectively.The differences in the above indexes between the two groups were statistically significant(P=0.018,P=0.014 and P=0.017 respectively).There was a total of 18 stents implanted in group A and 26 stents in group B.The follow-up time was from 6 to 24 months,no stents were obstructed and no complications such as displacement nor fracture were found.No pulmonary embolism occurred in either groups.Bleeding complications occurred in 2patients in group A,while the number of patients in group B was 3.Conclusion:For patients with acute DVT of left lower extremity secondary to severe iliac vein stenosis,the new treatment mode with iliac vein stent implanted before CDT could reduce the use of urokinase,shorten the catheterization time and cost less.Part 2 Angio Jet Thrombectomy Combined with Iliac Vein Stent Implantation for the Treatment of Acute Left Venous Deep Vein Thrombosis with Cockett SyndromeObjective:To evaluate the feasibility,safety and effectiveness of percutaneous mechanical thrombectomy(PMT)followed by directly stenting in treating acute deep venous thrombosis(DVT)with iliac vein compression syndrome(IVCS).Methods:During the period from April 2015 to July 2017,33 patients who had acute DVT with IVCS,including 13 males and 20 females with a mean age of(57.97±14.44)years old(ranging from 23 to 83 years old),were admitted to authors' hospital to receive treatment.Inferior vena cava filters were implanted in all patients prior to the treatment.Angio Jet thrombectomy,balloon angioplasty and iliac vein stent implantation were performed in the same setting.All patients received continuous transcatheter infusion of urokinase until the thrombosis was confirmed to be completely dissolved.The patients were followed up at outpatient clinic at 1,3,6 and 12 months after the treatment,and reexamination of color ultrasound and/or lower limb venography was used to assess the blood flow in the deep veins and in the stents.Results:The combination of several therapies was accomplished in a single session,the technical success rate was 100%.The procedure time for Angio Jet thrombectomy was(224.70±72.78)seconds.The thrombolysis time was(34.00±15.37)hours.The total used dosages of urokinase were(112.58±49.92)×104 U.33 stents were implanted directly after thrombectomy in 33 patients.Angiography postoperatively showed thrombus clearance rate of grade ? was obtained in 29 patients(87.88%,29/33)and ? in 4 patients(12.12%,4/33).There were no serious complications such as pulmonary embolism,severe hemorrhage,etc.Follow-up time from 6 to 24 months.Relapse of DVT was observed in one patient,color ultrasound and/or lower limb venography performed in the other 32 patients showed that the blood flow in deep veins and iliac vein stents was unobstructed.Conclusion:For the treatment of acute lower extremity DVT with Cockett syndrome,PMT combined with iliac vein stent implantation that is accomplished by single-session is safe and feasible.