Effects of catherter-directed thrombolysis in treatment of patients with deep venous thrombosis by analysis of 5-year follow up results_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DU Guocheng ¹ , YI Wen ¹ , ZHU Kepeng ¹ , YIN Junming ¹ ,  ZHANG Maochun ²

1. Department of Vascular Surgery, The Second Clinical School of North Sichuan Medical College (Nanchong Central Hospital), Nanchong, Sichuan 637000, P. R. China;
2. Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

ZHANG Maochun, Email: 18783919733@163.com

Keywords：

deep venous thrombosis; catherter-directed thrombolysis; postthrombotic syndrome

DOI：

10.7507/1007-9424.202008038

Video：

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Objective To compare the differences of incidence rate and severity of postthrombotic syndrome (PTS) of patients with lower extremity deep venous thrombosis (DVT) treated by catherter-directed thrombolysis (CDT) or via peripheral vein thrombolysis (PVT).Methods The patients with unilateral lower extremity DVT who had received anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2015 were collected. These patients were divided into CDT group and PVT group according to the different thrombolysis methods, and then the thrombolytic rates, thrombolytic complications, and the incidence rate and severity of PTS of 5-year follow up results were calculated and compared.Results A total of 137 cases of DVT were collected, 79 in the CDT group and 58 in the PVT group. There were no significant differences in the gender, age, course of disease, thrombus type, and other baseline data between the two groups (P>0.05). The thrombolytic rate of the CDT group was (78.6±16.3)% and PVT group was (27.3±12.1)%, the difference was significant (t=21.14, P<0.001). The rate of thrombolytic complications between the PVT group and CDT group had no statistical significance (32.8% versus 21.5%, χ²=2.18, P=0.134). The 5-year follow up was completed in 116 cases, 74 patients from the CDT group and 42 patients from the PVT group respectively, the result showed that the incidence rate of the PTS in the CDT group was lower than that in the PVT group (35.1% versus 88.1%, χ²=30.28, P<0.001), and theseverity of PTS in the CDT group was milder than that in the PVT group too (Z=16.52,P<0.001).Conclusion From the results of this study, CDT is able to increase thrombolytic rate and effectively reduce incidence rate and severity of PTS.

Citation： DU Guocheng, YI Wen, ZHU Kepeng, YIN Junming, ZHANG Maochun. Effects of catherter-directed thrombolysis in treatment of patients with deep venous thrombosis by analysis of 5-year follow up results. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(5): 601-605. doi: 10.7507/1007-9424.202008038 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.	Ashrani AA, Heit JA. Incidence and cost burden of post-thrombotic syndrome. J Thromb Thrombolysis, 2009, 28(4): 465-476.
3.	Comerota AJ. The ATTRACT trial: rationale for early intervention for iliofemoral DVT. Perspect Vasc Surg Endovasc Ther, 2009, 21(4): 221-224.
4.	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.
5.	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.
6.	Kahn SR, Desmarais S, Ducruet T, et al. Comparison of the Villalta and Ginsberg clinical scales to diagnose the post-thrombotic syndrome: correlation with patient-reported disease burden and venous valvular reflux. J Thromb Haemost, 2006, 4(4): 907-908.
7.	Kahn SR, Shbaklo H, Lamping DL, et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost, 2008, 6(7): 1105-1112.
8.	Wells P, Anderson D. The diagnosis and treatment of venous thromboembolism. Hematology Am Soc Hematol Educ Program, 2013, 2013: 457-463.
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.	Douketis JD, Crowther MA, Foster GA, et al. Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis? Am J Med, 2001, 110(7): 515-519.
11.	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.
12.	Vedantham S, Sista AK, Klein SJ, et al. Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol, 2014, 25(9): 1317-1325.
13.	Fleck D, Albadawi H, Shamoun F, et al. Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations. Cardiovasc Diagn Ther, 2017, 7(Suppl 3): S228-S237.
14.	Prandoni P, Kahn SR. Post-thrombotic syndrome: prevalence, prognostication and need for progress. Br J Haematol, 2009, 145(3): 286-295.
15.	Vedantham S. Valvular dysfunction and venous obstruction in the post-thrombotic syndrome. Thromb Res, 2009, 123 Suppl 4: S62-S65.
16.	Kahn SR. How I treat postthrombotic syndrome. Blood, 2009, 114(21): 4624-4631.
17.	van Dongen CJ, Prandoni P, Frulla M, et al. Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. J Thromb Haemost, 2005, 3(5): 939-942.
18.	Kim YA, Yang SS, Yun WS. Does catheter-directed thrombolysis prevent postthrombotic syndrome? Vasc Specialist Int, 2018, 34(2): 26-30.
19.	颜京强, 陈允惠, 张鲲, 等. AngioJet机械吸栓辅助治疗急性下肢深静脉血栓形成. 中国普外基础与临床杂志, 2019, 26(2): 168-173.
20.	Song XJ, Liu ZL, Zeng R, et al. The efficacy and safety of angiojet rheolytic thrombectomy in the treatment of subacute deep venous thrombosis in lower extremity. Ann Vasc Surg, 2019, 58: 295-301.
21.	Ozpak B, Ilhan G, Ozcem B, et al. Our short-term results with percutaneous mechanical thrombectomy for treatment of acute deep vein thrombosis. Thorac Cardiovasc Surg, 2016, 64(4): 316-322.
22.	Heller S, Lubanda JC, Varejka P, et al. Percutaneous mechanical thrombectomy using Rotarex® S device in acute limb ischemia in infrainguinal occlusions. Biomed Res Int, 2017, 2017: 2362769.
23.	Wong PC, Chan YC, Law Y, et al. Percutaneous mechanical thrombectomy in the treatment of acute iliofemoral deep vein thrombosis: a systematic review. Hong Kong Med J, 2019, 25(1): 48-57.
24.	Cao W, Shi H, Lu W, et al. Mid- and short-term efficacy of percutaneous mechanical thrombectomy in the treatment of acute iliofemoral deep vein thrombosis. Ann Vasc Surg, 2020, 68: 179-184.
25.	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.

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. Ashrani AA, Heit JA. Incidence and cost burden of post-thrombotic syndrome. J Thromb Thrombolysis, 2009, 28(4): 465-476.
3. Comerota AJ. The ATTRACT trial: rationale for early intervention for iliofemoral DVT. Perspect Vasc Surg Endovasc Ther, 2009, 21(4): 221-224.
4. 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.
5. 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.
6. Kahn SR, Desmarais S, Ducruet T, et al. Comparison of the Villalta and Ginsberg clinical scales to diagnose the post-thrombotic syndrome: correlation with patient-reported disease burden and venous valvular reflux. J Thromb Haemost, 2006, 4(4): 907-908.
7. Kahn SR, Shbaklo H, Lamping DL, et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost, 2008, 6(7): 1105-1112.
8. Wells P, Anderson D. The diagnosis and treatment of venous thromboembolism. Hematology Am Soc Hematol Educ Program, 2013, 2013: 457-463.
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. Douketis JD, Crowther MA, Foster GA, et al. Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis? Am J Med, 2001, 110(7): 515-519.
11. 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.
12. Vedantham S, Sista AK, Klein SJ, et al. Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol, 2014, 25(9): 1317-1325.
13. Fleck D, Albadawi H, Shamoun F, et al. Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations. Cardiovasc Diagn Ther, 2017, 7(Suppl 3): S228-S237.
14. Prandoni P, Kahn SR. Post-thrombotic syndrome: prevalence, prognostication and need for progress. Br J Haematol, 2009, 145(3): 286-295.
15. Vedantham S. Valvular dysfunction and venous obstruction in the post-thrombotic syndrome. Thromb Res, 2009, 123 Suppl 4: S62-S65.
16. Kahn SR. How I treat postthrombotic syndrome. Blood, 2009, 114(21): 4624-4631.
17. van Dongen CJ, Prandoni P, Frulla M, et al. Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. J Thromb Haemost, 2005, 3(5): 939-942.
18. Kim YA, Yang SS, Yun WS. Does catheter-directed thrombolysis prevent postthrombotic syndrome? Vasc Specialist Int, 2018, 34(2): 26-30.
19. 颜京强, 陈允惠, 张鲲, 等. AngioJet机械吸栓辅助治疗急性下肢深静脉血栓形成. 中国普外基础与临床杂志, 2019, 26(2): 168-173.
20. Song XJ, Liu ZL, Zeng R, et al. The efficacy and safety of angiojet rheolytic thrombectomy in the treatment of subacute deep venous thrombosis in lower extremity. Ann Vasc Surg, 2019, 58: 295-301.
21. Ozpak B, Ilhan G, Ozcem B, et al. Our short-term results with percutaneous mechanical thrombectomy for treatment of acute deep vein thrombosis. Thorac Cardiovasc Surg, 2016, 64(4): 316-322.
22. Heller S, Lubanda JC, Varejka P, et al. Percutaneous mechanical thrombectomy using Rotarex® S device in acute limb ischemia in infrainguinal occlusions. Biomed Res Int, 2017, 2017: 2362769.
23. Wong PC, Chan YC, Law Y, et al. Percutaneous mechanical thrombectomy in the treatment of acute iliofemoral deep vein thrombosis: a systematic review. Hong Kong Med J, 2019, 25(1): 48-57.
24. Cao W, Shi H, Lu W, et al. Mid- and short-term efficacy of percutaneous mechanical thrombectomy in the treatment of acute iliofemoral deep vein thrombosis. Ann Vasc Surg, 2020, 68: 179-184.
25. 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.

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Effects of catherter-directed thrombolysis in treatment of patients with deep venous thrombosis by analysis of 5-year follow up results

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