Comparative outcomes of catheter directed thrombolysis<i>vs</i> system thrombolysis in treatment of acute deep venous thrombosis in lower extremity _CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Kun ¹ , WANG Xiaokai ² , CHEN Jun ¹ ,  LIN Bin ¹ , SHI Xin ¹ , ZHAO Dongbo ¹ , SHI Jidong ¹

1. The Department of Hepatobiliary and Vascular Surgery, Nanjing Drum Tower Hospital Group Suqian City People’s Hospital, Suqian, Jiangsu 223800, P.R.China;
2. The Department of Vascular Surgery, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R.China;

Corresponding author：

LIN Bin, Email: linbin4486@163.com

Keywords：

deep vein thrombosis in lower extremity; catheter directed thrombolysis; system thrombolysis

DOI：

10.7507/1007-9424.201608056

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Objective To investigate the short-term result of catheter directed thrombolysis (CDT) in treatment of acute deep venous thrombosis (DVT) in lower extremity. Methods A total of 289 cases of acute DVT in lower extremity who got treatment in Nanjing Drum Tower Hospital Group Suqian City People’s Hospital and Xuzhou Central Hospital from March 2013 to December 2014 were enrolled prospectively, and of them, 125 cases of system thrombolysis (ST) group underwent ST, 164 cases of CDT group underwent inferior vena cava filter placement (IVCF)+CDT. Clinical effect was compared between the 2 groups. Results Clinical symptoms of all cases were obviously relieved, and limb swelling was significantly reduced. Of the CDT group, 73 cases presented iliac vein compression syndrome (IVCS), and 43 cases of them underwent the percutaneous transluminal angioplasty and stent implantation. In CDT group, there was 1 case complicated by catheter displacement, 10 cases suffered from puncture site ecchymosis, 3 cases suffered from hematuria. In ST group, there was 1 case suffered from pulmonary embolism (PE), 14 cases suffered from bleeding gums, 22 cases suffered from hematuria, 3 cases suffered from skin and mucosa petechia, and 2 cases suffered from melena (didn’t need transfusion). The morbidity of ST group was higher than that of CDT group (P=0.002). There were 18 cases suffered from recurrence in ST group, 15 cases suffered from recurrence in CDT group, but there was no significant difference in the recurrence rate between the 2 groups (P=0.786). In addition, the dosage of urokinase, thrombolysis time, blood vessel patency score, thigh circumference after treatment, and calf circumference after treatment in ST group were all higher than those of CDT group (P<0.050), but the Villalta score in ST group was lower than that of CDT group (P<0.001). There was no significant difference in hospital stay (P=0.383). Conclusion For acute DVT in lower extremity, CDT has a superior short-term outcome with safety and feasibility.

Citation： LIU Kun, WANG Xiaokai, CHEN Jun, LIN Bin, SHI Xin, ZHAO Dongbo, SHI Jidong. Comparative outcomes of catheter directed thrombolysisvs system thrombolysis in treatment of acute deep venous thrombosis in lower extremity . CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(3): 307-311. doi: 10.7507/1007-9424.201608056 Copy

1.	Kahn SR, Shrier I, Julian JA,et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med, 2008, 149(10): 698-707.
2.	中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南 (第 2 版). 中华外科杂志, 2012, 50(7): 611-614.
3.	刘坤, 陈军, 林斌, 等. 基层医院溶栓治疗急性下肢深静脉血栓形成的近期经验. 中国血管外科杂志(电子版), 2015, 7(1): 17-20.
4.	郭松林, 袁良喜, 周建, 等. 急性下肢深静脉血栓置管溶栓治疗的早、中期疗效分析. 中国血管外科杂志(电子版), 2013, 5(2): 86-89.
5.	Guyatt GH, Akl EA, Crowther M,et al. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): 7S-47S.
6.	Akesson H, Brudin L, Dahlstrom JA,et al. Venous function assessed during a 5 year period after acute ilio-femoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg, 1990, 4(1): 43-48.
7.	朱远志, 王洋, 罗军, 等. 导管溶栓治疗早期髂股静脉血栓形成的疗效及安全性系统评价. 中国普通外科杂志, 2010, 19(12): 1285-1291.
8.	Haig Y, Enden T, Slagsvold CE,et al. Determinants of early and long-term efficacy of catheter-directed thrombolysis in proximal deep vein thrombosis. J Vasc Interv Radiol, 2013, 24(1): 17-24.
9.	王孝运, 李晓强, 孟庆友, 等. 下肢深静脉血栓形成导管溶栓与系统溶栓治疗疗效对比研究. 中国血管外科杂志(电子版), 2015, 7(1): 13-16.
10.	Park C, So BJ. Long-term results of catheter-directed thrombolysis combined with iliac vein stenting for iliofemoral deep vein thrombosis. Vasc Specialist Int, 2015, 31(2): 47-53.
11.	王深明. 重视静脉血栓栓塞症的治疗. 岭南心血管病杂志, 2012, 18(4): 321-324.
12.	符伟国, 王利新. 围手术期静脉血栓栓塞疾病诊治争议与共识. 中国实用外科杂志, 2015, 35(1): 66-68.
13.	DU XL, Kong LS, Meng QY,et al. Safety and efficacy of low dosage of urokinase for catheter-directed thrombolysis of deep venous thrombosis. Chin Med J (Engl), 2015, 128(13): 1787-1792.
14.	李晓强, 孟庆友, 姜坤, 等. 下肢深静脉血栓形成导管溶栓术后髂静脉病变支架治疗的前瞻性对照性研究. 中国血管外科杂志(电子版), 2012, 4(1): 13-15.
15.	Xue GH, Huang XZ, Ye M,et al. Catheter-directed thrombolysis and stenting in the treatment of iliac vein compression syndrome with acute iliofemoral deep vein thrombosis: outcome and follow-up. Ann Vasc Surg, 2014, 28(4): 957-963.
16.	Choi JW, Jae HJ, Kim HC,et al. CT venography for deep venous thrombosis: can it predict catheter-directed thrombolysis prognosis in patients with iliac vein compression syndrome? Int J Cardiovasc Imaging, 2015, 31(2): 417-426.
17.	李彦州, 温志国, 杜丽苹, 等. Cockett 综合征并发深静脉血栓形成的腔内治疗. 中华普通外科杂志, 2013, 28(5): 368-370.
18.	戎建杰, 李晓强, 桑宏飞, 等. 血管腔内治疗下肢深静脉血栓形成. 中华普通外科杂志, 2010, 25(2): 155-157.
19.	Matsuda A, Yamada N, Ogihara Y,et al. Early and long-term outcomes of venous stent implantation for iliac venous stenosis after catheter-directed thrombolysis for acute deep vein thrombosis. Circ J, 2014, 78(5): 1234-1239.
20.	Bozkaya H, Cinar C, Ertugay S,et al. Endovascular treatment of iliac vein compression (May-Thurner) syndrome: angioplasty and stenting with or without manual aspiration thrombectomy and catheter-directed thrombolysis. Ann Vasc Dis, 2015, 8(1): 21-28.
21.	Ho WK, Hankey GJ, Eikelboom JW. The incidence of venous thromboembolism: a prospective, community-based study in Perth, Western Australia. Med J Aust, 2008, 189(3): 144-147.
22.	Bashir R, Zack CJ, Zhao H,et al. Comparative outcomes of catheter-directed thrombolysis plus anticoagulationvs anticoagulation alone to treat lower-extremity proximal deep vein thrombosis. JAMA Intern Med, 2014, 174(9): 1494-1501.
23.	李晓强, 于小滨. 导管接触性溶栓在急性下肢深静脉血栓形成治疗中的相关问题再探讨. 中国血管外科杂志(电子版), 2014, 6(1): 9-11.
24.	Grommes J, von Trotha K, Wolf MD,et al. Catheter-directed thrombolysis in deep vein thrombosis: which procedural measurement predicts outcome? Phlebology, 2014, 29(1 Suppl): 135-139.
25.	张皓. 下肢深静脉血栓形成后综合征的治疗策略. 中国血管外科杂志(电子版), 2015, 7(1): 7-8, 20.

1. Kahn SR, Shrier I, Julian JA,et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med, 2008, 149(10): 698-707.
2. 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南 (第 2 版). 中华外科杂志, 2012, 50(7): 611-614.
3. 刘坤, 陈军, 林斌, 等. 基层医院溶栓治疗急性下肢深静脉血栓形成的近期经验. 中国血管外科杂志(电子版), 2015, 7(1): 17-20.
4. 郭松林, 袁良喜, 周建, 等. 急性下肢深静脉血栓置管溶栓治疗的早、中期疗效分析. 中国血管外科杂志(电子版), 2013, 5(2): 86-89.
5. Guyatt GH, Akl EA, Crowther M,et al. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): 7S-47S.
6. Akesson H, Brudin L, Dahlstrom JA,et al. Venous function assessed during a 5 year period after acute ilio-femoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg, 1990, 4(1): 43-48.
7. 朱远志, 王洋, 罗军, 等. 导管溶栓治疗早期髂股静脉血栓形成的疗效及安全性系统评价. 中国普通外科杂志, 2010, 19(12): 1285-1291.
8. Haig Y, Enden T, Slagsvold CE,et al. Determinants of early and long-term efficacy of catheter-directed thrombolysis in proximal deep vein thrombosis. J Vasc Interv Radiol, 2013, 24(1): 17-24.
9. 王孝运, 李晓强, 孟庆友, 等. 下肢深静脉血栓形成导管溶栓与系统溶栓治疗疗效对比研究. 中国血管外科杂志(电子版), 2015, 7(1): 13-16.
10. Park C, So BJ. Long-term results of catheter-directed thrombolysis combined with iliac vein stenting for iliofemoral deep vein thrombosis. Vasc Specialist Int, 2015, 31(2): 47-53.
11. 王深明. 重视静脉血栓栓塞症的治疗. 岭南心血管病杂志, 2012, 18(4): 321-324.
12. 符伟国, 王利新. 围手术期静脉血栓栓塞疾病诊治争议与共识. 中国实用外科杂志, 2015, 35(1): 66-68.
13. DU XL, Kong LS, Meng QY,et al. Safety and efficacy of low dosage of urokinase for catheter-directed thrombolysis of deep venous thrombosis. Chin Med J (Engl), 2015, 128(13): 1787-1792.
14. 李晓强, 孟庆友, 姜坤, 等. 下肢深静脉血栓形成导管溶栓术后髂静脉病变支架治疗的前瞻性对照性研究. 中国血管外科杂志(电子版), 2012, 4(1): 13-15.
15. Xue GH, Huang XZ, Ye M,et al. Catheter-directed thrombolysis and stenting in the treatment of iliac vein compression syndrome with acute iliofemoral deep vein thrombosis: outcome and follow-up. Ann Vasc Surg, 2014, 28(4): 957-963.
16. Choi JW, Jae HJ, Kim HC,et al. CT venography for deep venous thrombosis: can it predict catheter-directed thrombolysis prognosis in patients with iliac vein compression syndrome? Int J Cardiovasc Imaging, 2015, 31(2): 417-426.
17. 李彦州, 温志国, 杜丽苹, 等. Cockett 综合征并发深静脉血栓形成的腔内治疗. 中华普通外科杂志, 2013, 28(5): 368-370.
18. 戎建杰, 李晓强, 桑宏飞, 等. 血管腔内治疗下肢深静脉血栓形成. 中华普通外科杂志, 2010, 25(2): 155-157.
19. Matsuda A, Yamada N, Ogihara Y,et al. Early and long-term outcomes of venous stent implantation for iliac venous stenosis after catheter-directed thrombolysis for acute deep vein thrombosis. Circ J, 2014, 78(5): 1234-1239.
20. Bozkaya H, Cinar C, Ertugay S,et al. Endovascular treatment of iliac vein compression (May-Thurner) syndrome: angioplasty and stenting with or without manual aspiration thrombectomy and catheter-directed thrombolysis. Ann Vasc Dis, 2015, 8(1): 21-28.
21. Ho WK, Hankey GJ, Eikelboom JW. The incidence of venous thromboembolism: a prospective, community-based study in Perth, Western Australia. Med J Aust, 2008, 189(3): 144-147.
22. Bashir R, Zack CJ, Zhao H,et al. Comparative outcomes of catheter-directed thrombolysis plus anticoagulationvs anticoagulation alone to treat lower-extremity proximal deep vein thrombosis. JAMA Intern Med, 2014, 174(9): 1494-1501.
23. 李晓强, 于小滨. 导管接触性溶栓在急性下肢深静脉血栓形成治疗中的相关问题再探讨. 中国血管外科杂志(电子版), 2014, 6(1): 9-11.
24. Grommes J, von Trotha K, Wolf MD,et al. Catheter-directed thrombolysis in deep vein thrombosis: which procedural measurement predicts outcome? Phlebology, 2014, 29(1 Suppl): 135-139.
25. 张皓. 下肢深静脉血栓形成后综合征的治疗策略. 中国血管外科杂志(电子版), 2015, 7(1): 7-8, 20.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative outcomes of catheter directed thrombolysisvs system thrombolysis in treatment of acute deep venous thrombosis in lower extremity

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