The efficacy of AngioJet thrombectomy combined with iliac vein stenting for patients diagnosed with acute lower extremity deep venous thrombosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Tao , SUN Bo , CAO Guangxin , ZHANG Jiefeng ,  SHANG Suiyuan

Department of Vascular Surgery, Weifang People’s Hospital, Weifang, Shandong 261000, P. R. China;

Corresponding author：

SHANG Suiyuan, Email: 1023771351@qq.com

Keywords：

deep vein thrombosis; AngioJet thrombectomy; inferior vena cava filter; iliac vein compression syndrome

DOI：

10.7507/1007-9424.202409071

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Objective To investigate the clinical efficacy of AngioJet thrombectomy combined with iliac vein stenting for patients diagnosed with acute lower extremity deep venous thrombosis (DVT) with iliac vein compression. Methods Between January 2021 and October 2023, a total of 64 patients with acute lower extremity DVT which performed AngioJet thrombectomy combined with iliac vein stenting in Weifang People’s Hospital were retrospectively analyzed. The changes of clinical symptoms, signs, and thrombus burden between pre- and postsurgically were observed. The venous patency score, thigh circumference, calf circumference, venous clinical severity score (VCSS), and chronicvenous insufficienc questionnaire-14item (CIVIQ-14) scores were recorded pre- and postsurgically, and the patency of stent was statistically evaluated by a comprehensive assessment of the postoperative 12-month angiography. Results Operative success was achieved in all the 64 patients. The aspiration time was 300－480 s [(313±32) s], and the operative time was 80－120 min [ (97±21.5) min]. No complications such as bleeding and hematoma occurred after operation. The hospitalization time was 5－12 d [ (7.5±2.8) d]. After operation, the patency score of vein and stent and the difference of thigh circumference diameter decreased or reduced, and the difference were statistically significant (P<0.001). The score of VCSS and CIVIQ-14 decreased or increased significantly after the operation, and the difference were statistically significant (P<0.05). Color Doppler ultrasound was performed at the first, third and sixth months after operation, and anterograde venography of lower limbs was performed at at the 12th month. Only one patient had thrombosis recurrence at one month after operation, and finally developed into post-thrombosis syndrome of deep veins of lower limbs after anticoagulant conservative treatment. The veins and stents of the rest patients were unobstructed. Conclusion AngioJet thrombectomy, together with iliac vein stenting, could effectively expedited clot removal, reduced limb swelling; prevented post-thrombotic syndrome recurrence and significantly improved quality of life for patients with acute lower extremity deep venous thrombosis.

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.	曾彦彰, 袁平, 何强. 导管接触溶栓与单纯抗凝治疗急性近端深静脉血栓形成的疗效对比研究. 中国普外基础与临床杂志, 2024, 31(3): 315-319.
3.	Strijkers RH, Arnoldussen CW, Wittens CH. Validation of the LET classification. Phlebology, 2015, 30(1 Suppl): 14-19.
4.	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 andomized controlled trial. Lancet, 2012, 379(9810): 31-38.
5.	Comerota AJ, Paolini D. Treatment of acute iliofemoral deep venous thrombosis: a strategy of thrombus removal. Eur J Vasc Endovasc Surg, 2007, 33(3): 351-360.
6.	Cakir V, Gulcu A, Akay E, et al. Use of percutaneous aspiration thrombectomy vs. anticoagulation therapy to treat acute iliofemoral venous thrombosis: 1-year follow-up results of a andomized, clinical trial. Cardiovasc Intervent Radiol, 2014, 37(4): 969-976.
7.	《血管与腔内血管外科杂志》编辑部, 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.
8.	中国医师协会介入医师分会, 中华医学会放射学分会介入专业委员会, 中国静脉介入联盟. 下肢深静脉血栓形成介入治疗规范的专家共识(第2版). 介入放射学杂志, 2019, 28(1): 1-10.
9.	Launois R, Le Moine JG, Lozano FS, et al. Construction and international validation of CIVIQ-14 (a short form of CIVIQ-20), a new questionnaire with a stable factorial structure. Qual Life Res, 2012, 21(6): 1051-1058.
10.	Khalil E, Ozcan S. The safety and efficacy of pharmaco-mechanical thrombolysis in lower-extremity deep venous thrombosis. Cardiovasc J Afr, 2020, 31(6): 286-290.
11.	Holbrook A, Schulman S, Witt DM, et al. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis. 9^th edn: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141 (2 Suppl): e152S-e184S. doi: 10.1378/chest.11-2295.
12.	Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s Choice—European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg, 2021, 61(1): 9-82.
13.	郭相江, 薛冠华. 下肢深静脉高负荷血栓评估及处理策略. 中国实用外科杂志, 2020, 40(5): 519-522.
14.	叶炜, 宋小军, 刘志丽, 等. 急性下肢深静脉血栓的血栓清除治疗—CDT 还是 PMT. 血管与腔内血管外科杂志, 2017, 3(1): 559-562.
15.	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.
16.	Robertson L, McBride O, Burdess A. Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis. Cochrane Database Syst Rev, 2016, 11(11): CD011536. doi: 10.1002/14651858.CD011536.pub2.
17.	Comerota AJ, Throm RC, Mathias SD, et al. Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life. J Vasc Surg, 2000, 32(1): 130-137.
18.	杜果城, 弋文, 朱克鹏, 等. 从5年随访结果评价置管溶栓治疗下肢深静脉血栓形成的疗效. 中国普外基础与临床杂志, 2021, 28(5): 601-605.
19.	Broderick C, Watson L, Armon MP. Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb. Cochrane Database Syst Rev, 2021, 1(1): CD002783. doi: 10.1002/14651858.CD002783.pub5.
20.	Lichtenberg MKW, Stahlhoff S, Młyńczak K, et al. Endovascular mechanical thrombectomy versus thrombolysis in patients with iliofemoral deep vein thrombosis—a systematic review and meta-analysis. Vasa, 2021, 50(1): 59-67.
21.	Wang CN, Deng HR. Percutaneous endovenous intervention plus anticoagulation versus anticoagulation alone for treating patients with proximal deep vein thrombosis: A meta-analysis and systematic review. Ann Vasc Surg, 2018, 49: 39-48.
22.	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.

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. 曾彦彰, 袁平, 何强. 导管接触溶栓与单纯抗凝治疗急性近端深静脉血栓形成的疗效对比研究. 中国普外基础与临床杂志, 2024, 31(3): 315-319.
3. Strijkers RH, Arnoldussen CW, Wittens CH. Validation of the LET classification. Phlebology, 2015, 30(1 Suppl): 14-19.
4. 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 andomized controlled trial. Lancet, 2012, 379(9810): 31-38.
5. Comerota AJ, Paolini D. Treatment of acute iliofemoral deep venous thrombosis: a strategy of thrombus removal. Eur J Vasc Endovasc Surg, 2007, 33(3): 351-360.
6. Cakir V, Gulcu A, Akay E, et al. Use of percutaneous aspiration thrombectomy vs. anticoagulation therapy to treat acute iliofemoral venous thrombosis: 1-year follow-up results of a andomized, clinical trial. Cardiovasc Intervent Radiol, 2014, 37(4): 969-976.
7. 《血管与腔内血管外科杂志》编辑部, 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.
8. 中国医师协会介入医师分会, 中华医学会放射学分会介入专业委员会, 中国静脉介入联盟. 下肢深静脉血栓形成介入治疗规范的专家共识(第2版). 介入放射学杂志, 2019, 28(1): 1-10.
9. Launois R, Le Moine JG, Lozano FS, et al. Construction and international validation of CIVIQ-14 (a short form of CIVIQ-20), a new questionnaire with a stable factorial structure. Qual Life Res, 2012, 21(6): 1051-1058.
10. Khalil E, Ozcan S. The safety and efficacy of pharmaco-mechanical thrombolysis in lower-extremity deep venous thrombosis. Cardiovasc J Afr, 2020, 31(6): 286-290.
11. Holbrook A, Schulman S, Witt DM, et al. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis. 9^th edn: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141 (2 Suppl): e152S-e184S. doi: 10.1378/chest.11-2295.
12. Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s Choice—European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg, 2021, 61(1): 9-82.
13. 郭相江, 薛冠华. 下肢深静脉高负荷血栓评估及处理策略. 中国实用外科杂志, 2020, 40(5): 519-522.
14. 叶炜, 宋小军, 刘志丽, 等. 急性下肢深静脉血栓的血栓清除治疗—CDT 还是 PMT. 血管与腔内血管外科杂志, 2017, 3(1): 559-562.
15. 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.
16. Robertson L, McBride O, Burdess A. Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis. Cochrane Database Syst Rev, 2016, 11(11): CD011536. doi: 10.1002/14651858.CD011536.pub2.
17. Comerota AJ, Throm RC, Mathias SD, et al. Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life. J Vasc Surg, 2000, 32(1): 130-137.
18. 杜果城, 弋文, 朱克鹏, 等. 从5年随访结果评价置管溶栓治疗下肢深静脉血栓形成的疗效. 中国普外基础与临床杂志, 2021, 28(5): 601-605.
19. Broderick C, Watson L, Armon MP. Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb. Cochrane Database Syst Rev, 2021, 1(1): CD002783. doi: 10.1002/14651858.CD002783.pub5.
20. Lichtenberg MKW, Stahlhoff S, Młyńczak K, et al. Endovascular mechanical thrombectomy versus thrombolysis in patients with iliofemoral deep vein thrombosis—a systematic review and meta-analysis. Vasa, 2021, 50(1): 59-67.
21. Wang CN, Deng HR. Percutaneous endovenous intervention plus anticoagulation versus anticoagulation alone for treating patients with proximal deep vein thrombosis: A meta-analysis and systematic review. Ann Vasc Surg, 2018, 49: 39-48.
22. 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.

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