Vein valve function following pharmacomechanical thrombectomy <i>versus</i> simple catheter-directed thrombolysis for lower extremity deep vein thrombosis: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENG Zhangbo , DING Hang , REN Fei , LAN Yongrong , LI Chunping , LEI Yunhong ,  HAN Tao

Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, 350001, P.R.China;

Corresponding author：

HAN Tao, Email: fjsxxwk@163.com

Keywords：

Deep vein thrombosis; pharmacomechanical thrombolysis; catheter-directed thrombolysis; femoral vein valve function

DOI：

10.7507/1007-4848.201805005

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Objective To compare vein valve function following pharmacomechanical thrombolysis (PMT) with simple catheter-directed thrombolysis (CDT) for deep vein thrombosis.Methods We retrospectively analyzed the clinical data of sixty patients who suffered acute lower extremity deep vein thrombsis in our hospital between October 2016 and March 2017. All patients underwent contralateral preprocedural duplex and bilateral postprocedure duplex to access patency and valve function. The patients were divided into three groups including a group A with catheter-directed thrombolysis (CDT) alone (36 patients with 20 males and 16 females at average age of 56 years), a group B with PMT alone (15 patients with 8 males and 7 females at average age of 55 years), and a group C with PMT combined CDT (9 patients with 4 males and 5 females at average age of 56 years). The valve function was compared among the Group A, Group B and Group C.Results There were 40.0% (24/60) patients with bilateral femoral vein valve reflux, 40.0% (24/60) patients with unilateral femoral vein valve reflux (all in the treated limbs), 20% (12/60) patients had no reflux in both limbs. Of the limbs treated with CDT alone, PMT alone and PMT combined CDT, the rate of valve reflux was 38.9% (14/36), 33.3% (5/15), and 55.6% (5/9) respectively (P=0.077).Conclusion In the patients suffering acute DVT, PMT or PMT combined CDT does not hamper valve function compared with CDT alone.

Citation： CHENG Zhangbo, DING Hang, REN Fei, LAN Yongrong, LI Chunping, LEI Yunhong, HAN Tao. Vein valve function following pharmacomechanical thrombectomy versus simple catheter-directed thrombolysis for lower extremity deep vein thrombosis: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(2): 148-151. doi: 10.7507/1007-4848.201805005 Copy

1.	Roddy SP. Quantity of clot lysed after catheter-directed thrombolysis for iliofemoral deep vein thrombosis correlates with postthrombotic morbidity. J Vasc Surg, 2010, 51(5): 1318-1319.
2.	Dasari TW, Pappy R, Hennebry TA. Pharmacomechanical thrombolysis of acute and chronic symptomatic deep vein thrombosis: a systematic review of literature. Angiology, 2012, 63(2): 138-145.
3.	Malgor RD, Gasparis AP. Pharmaco-mechanical thrombectomy for early thrombus removal. Phlebology, 2012, 27(Suppl 1): 155-162.
4.	Robertson L, McBride O, Burdess A. Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis. Cochrane Database Syst Rev, 2016, 11: CD011536.
5.	Garcia MJ, Lookstein R, Malhotra R, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: Final report of the prospective multicenter PEARL (peripheral use of angioJet rheolytic thrombectomy with a variety of catheter lengths) registry. J Vasc Interv Radiol, 2015, 26(6): 777-785.
6.	Vedantham S, Goldhaber SZ, Kahn SR, et al. Rationale and design of the ATTRACT Study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J, 2013, 165(4): 523-530.
7.	Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg, 2011, 53(5 Suppl): 2S-48S.
8.	仇鹏, 司小毛, 查斌山, 等. 溶栓联合抗凝与单纯抗凝治疗下肢深静脉血栓疗效及安全性Meta分析. 中华普通外科杂志, 2014, 29(6): 467-470.
9.	Huang CY, Hsu HL, Kuo TT, et al. Percutaneous pharmacomechanical thrombectomy offers lower risk of post-thrombotic syndrome than catheter-directed thrombolysis in patients with acute deep vein thrombosis of the lower limb. Ann Vasc Surg, 2015, 29(5): 995-1002.
10.	Kuo TT, Huang CY, Hsu CP, et al. Catheter-directed thrombolysis and pharmacomechanical thrombectomy improve midterm outcome in acute iliofemoral deep vein thrombosis. J Chin Med Assoc, 2017, 80(2): 72-79.
11.	Stanley GA, Murphy EH, Plummer MM, et al. Midterm results of percutaneous endovascular treatment for acute and chronic deep venous thrombosis. J Vasc Surg Venous Lymphat Disord, 2013, 1(1): 52-58.
12.	Lin PH, Zhou W, Dardik A, et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg, 2006, 192(6): 782-788.
13.	段鹏飞, 倪才方, 刘凯, 等. 药物-机械偶联式血栓清除术治疗急性下肢深静脉血栓形成. 中华普通外科杂志, 2016, 31(4): 338-339.
14.	Casanegra AI, McBane RD, Bjarnason H. Intervention radiology for venous thrombosis: early thrombus removal using invasive methods. Br J Haematol, 2017, 177(2): 173-184.
15.	van Haarst EP, Liasis N, van Ramshorst B, et al. The development of valvular incompetence after deep vein thrombosis: a 7 year follow-up study with duplex scanning. Eur J Vasc Endovasc Surg, 1996, 12(3): 295-299.
16.	Du GC, Zhang MC, Zhao JC. Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis. Vasa, 2015, 44(3): 195-202.
17.	Kim HS, Patra A, Paxton BE, et al. Catheter-directed thrombolysis with percutaneous rheolytic thrombectomy versus thrombolysis alone in upper and lower extremity deep vein thrombosis. Cardiovasc Intervent Radiol, 2006, 29(6): 1003-1007.
18.	Pianta MJ, Thomson KR. Catheter-directed thrombolysis of lower limb thrombosis. Cardiovasc Intervent Radiol, 2011, 34(1): 25-36.

1. Roddy SP. Quantity of clot lysed after catheter-directed thrombolysis for iliofemoral deep vein thrombosis correlates with postthrombotic morbidity. J Vasc Surg, 2010, 51(5): 1318-1319.
2. Dasari TW, Pappy R, Hennebry TA. Pharmacomechanical thrombolysis of acute and chronic symptomatic deep vein thrombosis: a systematic review of literature. Angiology, 2012, 63(2): 138-145.
3. Malgor RD, Gasparis AP. Pharmaco-mechanical thrombectomy for early thrombus removal. Phlebology, 2012, 27(Suppl 1): 155-162.
4. Robertson L, McBride O, Burdess A. Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis. Cochrane Database Syst Rev, 2016, 11: CD011536.
5. Garcia MJ, Lookstein R, Malhotra R, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: Final report of the prospective multicenter PEARL (peripheral use of angioJet rheolytic thrombectomy with a variety of catheter lengths) registry. J Vasc Interv Radiol, 2015, 26(6): 777-785.
6. Vedantham S, Goldhaber SZ, Kahn SR, et al. Rationale and design of the ATTRACT Study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J, 2013, 165(4): 523-530.
7. Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg, 2011, 53(5 Suppl): 2S-48S.
8. 仇鹏, 司小毛, 查斌山, 等. 溶栓联合抗凝与单纯抗凝治疗下肢深静脉血栓疗效及安全性Meta分析. 中华普通外科杂志, 2014, 29(6): 467-470.
9. Huang CY, Hsu HL, Kuo TT, et al. Percutaneous pharmacomechanical thrombectomy offers lower risk of post-thrombotic syndrome than catheter-directed thrombolysis in patients with acute deep vein thrombosis of the lower limb. Ann Vasc Surg, 2015, 29(5): 995-1002.
10. Kuo TT, Huang CY, Hsu CP, et al. Catheter-directed thrombolysis and pharmacomechanical thrombectomy improve midterm outcome in acute iliofemoral deep vein thrombosis. J Chin Med Assoc, 2017, 80(2): 72-79.
11. Stanley GA, Murphy EH, Plummer MM, et al. Midterm results of percutaneous endovascular treatment for acute and chronic deep venous thrombosis. J Vasc Surg Venous Lymphat Disord, 2013, 1(1): 52-58.
12. Lin PH, Zhou W, Dardik A, et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg, 2006, 192(6): 782-788.
13. 段鹏飞, 倪才方, 刘凯, 等. 药物-机械偶联式血栓清除术治疗急性下肢深静脉血栓形成. 中华普通外科杂志, 2016, 31(4): 338-339.
14. Casanegra AI, McBane RD, Bjarnason H. Intervention radiology for venous thrombosis: early thrombus removal using invasive methods. Br J Haematol, 2017, 177(2): 173-184.
15. van Haarst EP, Liasis N, van Ramshorst B, et al. The development of valvular incompetence after deep vein thrombosis: a 7 year follow-up study with duplex scanning. Eur J Vasc Endovasc Surg, 1996, 12(3): 295-299.
16. Du GC, Zhang MC, Zhao JC. Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis. Vasa, 2015, 44(3): 195-202.
17. Kim HS, Patra A, Paxton BE, et al. Catheter-directed thrombolysis with percutaneous rheolytic thrombectomy versus thrombolysis alone in upper and lower extremity deep vein thrombosis. Cardiovasc Intervent Radiol, 2006, 29(6): 1003-1007.
18. Pianta MJ, Thomson KR. Catheter-directed thrombolysis of lower limb thrombosis. Cardiovasc Intervent Radiol, 2011, 34(1): 25-36.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Vein valve function following pharmacomechanical thrombectomy versus simple catheter-directed thrombolysis for lower extremity deep vein thrombosis: A case control study

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