AngioJet mechanical thrombectomy in treatment of acute deep venous thrombosis of lower extremities_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YAN Jingqiang , CHEN Yunhui , ZHANG Kun , QI Haoshan , ZHAO Juncheng ,  LI Dalin

Department of Vascular Surgery, Qingdao Municipal Hospital, Qingdao, Shandong 266071, P. R. China;

Corresponding author：

LI Dalin, Email: dalinliqd@126.com

Keywords：

deep venous thrombosis; lower extremity; mechanical thrombectomy; catheter directed thrombolysis

DOI：

10.7507/1007-9424.201810014

Video：

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Objective To evaluate the effect of percutaneous mechanical thrombectomy (PMT) with AngioJet mechanical thrombus aspiration system for the acute deep venous thrombosis (DVT) of lower extremities. Methods The clinical data of 72 patients (72 limbs) with acute DVT who underwent PMT with AngioJet system from December 2015 to June 2018 in our hospital were analyzed retrospectively. Results Of the 72 cases, 30 cases underwent PMT alone, while 42 cases underwent PMT combined with catheter directed thrombolysis (CDT). Thrombus clearance rate of grade Ⅲ was obtained in 49 cases (68.05%), grade Ⅱ in 20 cases (27.78%), and grade Ⅰ in 3 cases (4.17%). Thirty-five cases were found with May-Thurner syndrome, and 34 cases were treated with stenting while 1 case complicated with iliac bleeding. The rates of PTS were 1.41% (1/71), 3.57% (2/56), 4.55% (2/44), and 20.00% (3/15) at 3-month, 6-month, 1-year, and 2-year after intervention, respectively. The deep vein patency rates were 86.36% (38/44) and 80.00% (12/15) at 1-year and 2-year after intervention, respectively. The iliac stent patency rates were 100% (23/23) and 87.50% (7/8) at 1-year and 2-year after intervention, respectively. Conclusion The effect of PMT assisted with CDT for the acute DVT of lower extremities is satisfactory, but its long-term efficacy needs to be further observed.

Citation： YAN Jingqiang, CHEN Yunhui, ZHANG Kun, QI Haoshan, ZHAO Juncheng, LI Dalin. AngioJet mechanical thrombectomy in treatment of acute deep venous thrombosis of lower extremities. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(2): 168-173. doi: 10.7507/1007-9424.201810014 Copy

1.	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 (第三版). 中国血管外科杂志: 电子版, 2017, 9(4): 250-257.
2.	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.
3.	下肢静脉疾病外科治疗专家协作组. AngioJet 机械血栓清除术治疗急性下肢深静脉血栓形成的专家共识 (2016 版). 血管与腔内血管外科杂志, 2017, 3(1): 555-558.
4.	Mewissen MW, Seabrook GR, Meissner MH, et al. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology, 1999, 211(1): 39-49.
5.	Kahn SR, Partsch H, Vedantham S, et al. Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization. J Thromb Haemost, 2009, 7(5): 879-883.
6.	Liddell RP, Evans NS. May-Thurner syndrome. Vasc Med, 2018, 23(5): 493-496.
7.	Nicolaides A, Kakkos S, Eklof B, et al. Management of chronic venous disorders of the lower limbs-guidelines according to scientific evidence. Int Angiol, 2014, 33(2): 87-208.
8.	Srinivas BC, Patra S, Nagesh CM, et al. Catheter-directed thrombolysis along with mechanical thromboaspiration versus anticoagulation alone in the management of lower limb deep venous thrombosis–a comparative study. Int J Angiol, 2014, 23(4): 247-254.
9.	Kahn SR, Comerota AJ, Cushman M, et al. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation, 2014, 130(18): 1636-1661.
10.	Rabinovich A, Kahn SR. The postthrombotic syndrome: current evidence and future challenges. J Thromb Haemost, 2017, 15(2): 230-241.
11.	Meissner MH, Gloviczki P, Comerota AJ, et al. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg, 2012, 55(5): 1449-1462.
12.	刘存发, 张秀军, 黄梅, 等. Angiojet 抽吸导管在下肢深静脉血栓治疗中的应用. 血管与腔内血管外科杂志, 2016, 2(2): 112-115.
13.	刘磊, 冯家煊, 王宏飞, 等. 下肢深静脉血栓形成的 AngioJet 机械吸栓与置管溶栓的对比研究. 中华血管外科杂志, 2016, 1(1): 22-25.
14.	Manninen H, Juutilainen A, Kaukanen E, et al. Catheter-directed thrombolysis of proximal lower extremity deep vein thrombosis: a prospective trial with venographic and clinical follow-up. Eur J Radiol, 2012, 81(6): 1197-1202.
15.	Haig Y, Enden T, Grøtta O, et al. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol, 2016, 3(2): e64-e71.
16.	Enden T, Haig Y, Kløw NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet, 2012, 379(9810): 31-38.
17.	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.
18.	Park KM, Moon IS, Kim JI, et al. Mechanical thrombectomy with Trerotola compared with catheter-directed thrombolysis for treatment of acute iliofemoral deep vein thrombosis. Ann Vasc Surg, 2014, 28(8): 1853-1861.
19.	Jenkins JS, Michael P. Deep venous thrombosis: an interventionalist’s approach. Ochsner J, 2014, 14(4): 633-640.
20.	Karthikesalingam A, Young EL, Hinchliffe RJ, et al. A systematic review of percutaneous mechanical thrombectomy in the treatment of deep venous thrombosis. Eur J Vasc Endovasc Surg, 2011, 41(4): 554-565.
21.	刘凯, 段鹏飞, 陈珑, 等. AngloJet 血栓清除装置治疗急性下肢深静脉血形成初步临床应用. 介入放射学杂志, 2016, 25(6): 496-500.
22.	Dumantepe M, Uyar I. The effect of Angiojet rheolytic thrombectomy in the endovascular treatment of lower extremity deep venous thrombosis. Phlebology, 2018, 33(6): 388-396.
23.	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.
24.	孙缙红, 张鸿坤, 吴子衡, 等. AngioJet 机械吸栓在下肢深静脉血栓形成中的应用及疗效观察. 中华普通外科杂志, 2018, 33(7): 578-581.
25.	毛由军, 李承龙, 雷锋锐, 等. AngioJet 机械性血栓抽吸系统联合 CDT 治疗急性下肢深静脉血栓的疗效分析. 中华医学杂志, 2017, 97(34): 2687-2690.
26.	Arko FR, Davis CM 3^rd, Murphy EH, et al. Aggressive percutaneous mechanical thrombectomy of deep venous thrombosis: early clinical results. Arch Surg, 2007, 142(6): 513-518.
27.	Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST Guideline and Expert Panel Report. Chest, 2016, 149(2): 315-352.
28.	Narayan A, Eng J, Carmi L, et al. Iliac vein compression as risk factor for left- versus right-sided deep venous thrombosis: case-control study. Radiology, 2012, 265(3): 949-957.
29.	Liu G, Qin J, Cui C, et al. Comparison of direct iliofemoral stenting following angioJet rheolytic thrombectomy vs staged stenting after AngioJet rheolytic thrombectomy plus catheter-directed thrombolysis in patients with acute deep vein thrombosis. J Endovasc Ther, 2018, 25(1): 133-139.

1. 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 (第三版). 中国血管外科杂志: 电子版, 2017, 9(4): 250-257.
2. 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.
3. 下肢静脉疾病外科治疗专家协作组. AngioJet 机械血栓清除术治疗急性下肢深静脉血栓形成的专家共识 (2016 版). 血管与腔内血管外科杂志, 2017, 3(1): 555-558.
4. Mewissen MW, Seabrook GR, Meissner MH, et al. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology, 1999, 211(1): 39-49.
5. Kahn SR, Partsch H, Vedantham S, et al. Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization. J Thromb Haemost, 2009, 7(5): 879-883.
6. Liddell RP, Evans NS. May-Thurner syndrome. Vasc Med, 2018, 23(5): 493-496.
7. Nicolaides A, Kakkos S, Eklof B, et al. Management of chronic venous disorders of the lower limbs-guidelines according to scientific evidence. Int Angiol, 2014, 33(2): 87-208.
8. Srinivas BC, Patra S, Nagesh CM, et al. Catheter-directed thrombolysis along with mechanical thromboaspiration versus anticoagulation alone in the management of lower limb deep venous thrombosis–a comparative study. Int J Angiol, 2014, 23(4): 247-254.
9. Kahn SR, Comerota AJ, Cushman M, et al. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation, 2014, 130(18): 1636-1661.
10. Rabinovich A, Kahn SR. The postthrombotic syndrome: current evidence and future challenges. J Thromb Haemost, 2017, 15(2): 230-241.
11. Meissner MH, Gloviczki P, Comerota AJ, et al. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg, 2012, 55(5): 1449-1462.
12. 刘存发, 张秀军, 黄梅, 等. Angiojet 抽吸导管在下肢深静脉血栓治疗中的应用. 血管与腔内血管外科杂志, 2016, 2(2): 112-115.
13. 刘磊, 冯家煊, 王宏飞, 等. 下肢深静脉血栓形成的 AngioJet 机械吸栓与置管溶栓的对比研究. 中华血管外科杂志, 2016, 1(1): 22-25.
14. Manninen H, Juutilainen A, Kaukanen E, et al. Catheter-directed thrombolysis of proximal lower extremity deep vein thrombosis: a prospective trial with venographic and clinical follow-up. Eur J Radiol, 2012, 81(6): 1197-1202.
15. Haig Y, Enden T, Grøtta O, et al. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol, 2016, 3(2): e64-e71.
16. Enden T, Haig Y, Kløw NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet, 2012, 379(9810): 31-38.
17. 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.
18. Park KM, Moon IS, Kim JI, et al. Mechanical thrombectomy with Trerotola compared with catheter-directed thrombolysis for treatment of acute iliofemoral deep vein thrombosis. Ann Vasc Surg, 2014, 28(8): 1853-1861.
19. Jenkins JS, Michael P. Deep venous thrombosis: an interventionalist’s approach. Ochsner J, 2014, 14(4): 633-640.
20. Karthikesalingam A, Young EL, Hinchliffe RJ, et al. A systematic review of percutaneous mechanical thrombectomy in the treatment of deep venous thrombosis. Eur J Vasc Endovasc Surg, 2011, 41(4): 554-565.
21. 刘凯, 段鹏飞, 陈珑, 等. AngloJet 血栓清除装置治疗急性下肢深静脉血形成初步临床应用. 介入放射学杂志, 2016, 25(6): 496-500.
22. Dumantepe M, Uyar I. The effect of Angiojet rheolytic thrombectomy in the endovascular treatment of lower extremity deep venous thrombosis. Phlebology, 2018, 33(6): 388-396.
23. 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.
24. 孙缙红, 张鸿坤, 吴子衡, 等. AngioJet 机械吸栓在下肢深静脉血栓形成中的应用及疗效观察. 中华普通外科杂志, 2018, 33(7): 578-581.
25. 毛由军, 李承龙, 雷锋锐, 等. AngioJet 机械性血栓抽吸系统联合 CDT 治疗急性下肢深静脉血栓的疗效分析. 中华医学杂志, 2017, 97(34): 2687-2690.
26. Arko FR, Davis CM 3^rd, Murphy EH, et al. Aggressive percutaneous mechanical thrombectomy of deep venous thrombosis: early clinical results. Arch Surg, 2007, 142(6): 513-518.
27. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST Guideline and Expert Panel Report. Chest, 2016, 149(2): 315-352.
28. Narayan A, Eng J, Carmi L, et al. Iliac vein compression as risk factor for left- versus right-sided deep venous thrombosis: case-control study. Radiology, 2012, 265(3): 949-957.
29. Liu G, Qin J, Cui C, et al. Comparison of direct iliofemoral stenting following angioJet rheolytic thrombectomy vs staged stenting after AngioJet rheolytic thrombectomy plus catheter-directed thrombolysis in patients with acute deep vein thrombosis. J Endovasc Ther, 2018, 25(1): 133-139.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

AngioJet mechanical thrombectomy in treatment of acute deep venous thrombosis of lower extremities

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