| Object: To evaluate the merits and demerits of pharmaco-mechanical thrombolysis for the management of acute deep vein thrombosis by comparing with catheter-directed thrombolysis.Methods: Seventy patients with acute lower extremity deep vein thrombosis from the second hospital of soochow university and Tai-Chang hospital were reviewed restropectivey.The patients were divided into two groups via the different treatment including CDT alone and AngioJet thrombectomy combined with CDT.Inferior vena cava filter was implanted before CDT or AngioJet thrombectomy.The latter was performed as the followed steps.Firstly,urokinase was sprayed into the thrombi in some patients.And then aspiration was done by the AngioJet machine.If there was residual thrombus,CDT was performed via the ipsilateral route,such as ipsilateral femoral vein,anterior tibial veins and posterior tibial veins.Percutaneous transluminal angioplasty and subsequent stenting was performed if there was stenosis or occlusion in the iliac vein.All these treatment were performed at the basis of adequate anticoagulation with lower weight molecular heprin in a dose of 4100 U per 12 hours.All the patients were administrated to wear elastic stocking and to elevate the limbs.During CDT,venography was performed every other day.The site of catheter was adjusted via the results of venography.The difference of cross-section diameter was calculated between the bilateral lower extremities everyday.Anticoagulation with Warfarin or Rivaroxaban was taken at least of 6 months during the follow-up.International normalized ratio was required among 2 to 3.Comparison between the two groups was performed to identify the advantage of AngioJet thrombectomy in the duration of CDT,dosage of urokinase,the descent velocity of D-dimer,days of hospitalization,grade of venous patency postoperation and the occurrence of post-thrombotic syndrome.Results:1.Among the 70 patients with acute DVT,there were 35 cases performed CDT alone,including 11 male and 24 female,29 left lower extremities and 6 right lower extremities,8 center and 27 mixed DVT.While there were 35 cases performed AngioJet thrombectomy,including 8 male and 27 female,30 left and 5 right lower extremities,5 center and 30 mixed DVT.The durations of CDT were(6.09 ± 1.81)days and(2.89 ± 1.53)days in CDT alone group and AngioJet thrombotecmy group,respectively.There was a significant difference(t=8.002,P < 0.0001).The dosages of urokinase were 2.51 ± 0.98 million U and 1.10 ± 0.55 million U,respectively.There was also a significant difference(t= 7.473,P=0.001).There was a significant difference in the descent velocity of D-dimer between the two groups(2144.68 ± 1464.08 vs 3268.66 ± 2238.04,t=-2.486,P= 0.028).There was also a significant difference in the days of hospitalization between the two groups(12.09 ± 4.75 vs 5.51 ± 1.48 days,t=7.815,P < 0.0001).2.There were no significant difference between A and B groups in cross-section diameter(3.17 ± 0.92 vs 2.23 ± 0.88,t=4.380,P= 0.453),grade of venous patency postoperation(2.0 ± 1.16 vs 1.11 ± 0.87,t=3.612,P=0.246)and the occurrence of post-thrombotic syndrome(14.29% vs 8.57%,χ2= 0.5645,P=0.4524).Conclusion:1.AngioJet thrombotecmy could decrease the duration of CDT and the dosage of urokinase when it was used to treat lower extremity DVT.But it could accelerate the descent velocity of D-dimer with a less complication compared with CDT alone.It could also shorten the days of hospitalization,especially for the patients with contraindication with thrombolysis.2.It could not promote the grade of venous patency of CDT and not prevent the occurrence of PTS via AngioJet thrombotecmy.3.Pharmaco-mechanical thrombectomy,with a good short-term effects,is an ideal choice for acute DVT patients.But the mid-and long-term patencies of the veins need further studies. |
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