Clinical Application And Curative Effect Analysis Of Percutaneous Pharmacomechanical Thrombosis In The Treatment Of Acute Or Subacute Deep Venous Thrombosis Of Lower Extremity

Objective:Angiojet mechanical thrombectomy device combined with anticoagulant and thrombolytic drugs for rapid removal of acute or subacute deep vein thrombosis of lower extremity clinical efficacy analysis.Method:A total of 28 patients with acute and subacute deep venous thrombosis(DVT)of the lower extremity treated with Angiojet mechanical thrombectomy device combined with anticoagulant and thrombolytic drugs at vascular surgery of Jinan Central Hospital from August 2016 to June 2018 were enrolled in this study.All patients were routinely placed inferior vena cava filter(IVCF)and treated with Angiojet thrombus clearance device(Boston Science,USA)during operation.According to the doctor’s advice,patients and their families’ wishes,15 cases without catheter-directed thrombolysis(CDT)were defined as group A and 13 cases with CDT were defined as group B.Evaluation criteria of A and B groups: Venous patency score,thrombus clearance rate,limb circumference change and detumes-cence rate before and 7 days after operation,operation time,Angiojet thrombus aspiration time and thrombus aspiration volume,thrombolytic dosage,hospitalization days,preope-rative and postoperative renal function assessment,intraoperative and postoperative complications,lumen patency rate at end-point of follow-up.In addition,the incidence and severity of post-thrombotic syndrome(PTS)at 12 months after surgery were assessed with the modified Villalta scale.The Venous Clinical Severity Score(VCSS)was completed preoperatively and 12 months postoperatively.The venous insufficiency epidemiological and economic studies(VEINES)questionnaire,including the quality of life(QOL)and clinical symptoms(Sym),were completed preoperatively and 12 months postoperatively.Results:The score of venous patency in group A decreased from preoperative(7.13±1.51)to postoperative(0.60±0.74),Z =-3.450,P = 0.01,while that in group B decreased from preoperative(7.38±1.61)to postoperative(2.00±1.23),Z =-3.187,P = 0.01.The thrombus clearance rates of group A and group B were(85.35±23.35)%,(70.56±19.13)%,t=1.815,P=0.081,95% confidence interval was(-1.959—31.543).There was no difference between the two groups.There was no grade I clearance in group A,7(46.7%)had grade II clearance,8(53.3%)had grade III clearance,3(23.1%)had grade I clearance in group B,9(69.2%)had grade II clearance,and 1(7.7%)had grade III clearance;group A was superior to group B(= 8.163,P = 0.007).The perimeter difference of 20 cm above the knee in group A decreased from preoperative(8.67±1.447)cm to(1.60±0.910)cm,Z =-3.431,P = 0.001.In group B,the perimeter difference of 20 cm above the knee decreased from(9.08±0.862)cm before operation to(2.92±1.553)cm,Z=-3.195,P=0.001.A and B two groups of thigh detumescence rate was(81.31±9.63)%,(62.88±24.26)%,t=2.569,P=0.021,95% confidence interval was(31.61-33.70),respectively.In group A,the perimeter difference of 15 cm below the knee decreased from(3.73±1.163)cm before operation to(1.53±0.640)cm after operation,Z =-3.461,P = 0.001.The circumference of15 cm below the knee in group B decreased from preoperative(4.00±0.816)cm to postoperative(2.15±0.689)cm,Z =-3.228,P = 0.001.The calf detumescence rates of group A and group B were(58.11±13.58)%,(44.86±17.49)%,t = 2.255,P = 0.033,95%confidence intervals was(1.171-25.332).The detumescence rate in group A was better than that in group B.Villaita scores in group A and group B were(1.60±0.910),(4.08±2.691),t=-3.165,P=0.007,and 95% confidence interval was(-4.151—-0.803).There was no PTS in group A,but in group B,3 cases had mild PTS and 1 cases had moderate PTS.The severity of the two groups of PTS was tested by chi-square test,=8 163,P=0 007,and B group was more severe than A group.The VCSS score of group A decreased from preoperative(4.47±1.125)to postoperative 12 months(1.47±0.640),Z =-3.475,P = 0.001.The VCSS score of group B decreased from preoperative(6.54±2.402)to postoperative 12months(1.92±1.115),Z =-3.197,P = 0.001.The VEINES-QOL/Sym questionnaires of both groups A and B at preoperative and end-point of follow-up: Group A score(Z=-3.411,P = 0.001)and Group B score(Z=-3.180,P= 0.001)were significantly improved,however,there was no significant change in the score of PTS patients.Thrombus clearance for grade II and above and successful completion of surgery is defined as successful operation,the success rate of operation was 91.43%,;and the improvement of clinical symptoms was defined as clinical success,the clinical success rate was 100%.There were 3 cases of sinus bradycardia,4 cases of chest tightness and wheezing,suspected of transient pulmonary embolism,1 case of puncture point hematoma,1 case of black stool,no case of craniocerebral and retroperitoneal hemorrhage,no case of renal function injury,no patient death and other surgical-related complications.At the end of 12 months follow-up,31 cases(88.57%)had partial recanalization,3 cases had mild PTS,1 case had moderate PTS,the incidence of PTS was 14.29%.Conclusion:Angiojet mechanical-drug thrombectomy or combined with other adjuvant treatment can quickly remove the acute and subacute deep vein thrombosis load of lower limbs,restore the blood flow of thrombovenous lumen,greatly improve the clinical symptoms of patients.This technique is safe,effective,easy to operate,highly feasible,and less complications,is a good endovascular treatment.