Minimally Invasive Therapy in Acute Deep Venous Thrombosis of Lower Extremities_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Xiquan , WANG Yiping , PAN Jingjing , ZHU Wei , LI Changhai , GUO Feng , DONG Ge , ZHANG Qing

Department of Interventional Vascular， The 148th Hospital of Chinese People’s Liberation Army， Zibo 255300， Shandong Province， China;

Corresponding author：

Keywords：

Deep venous thrombosis; Aspiration of thrombus; Thrombolysis of endovascular; Interventional therapy

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Objective 　To discuss the clinical effect and value of minimally invasive therapy on lower extremity deep venous thrombosis （DVT）.
Methods 　The clinical data of 911 patients with acute lower extremity DVT from April 1998 to December 2011 were analyzed retrospectively. There were 489 males，422 females；the age ranged from 23-86 years old with （58.72±11.95） years old. Five hundred and sixty-eight patients occurred on the left leg，343 patients on the right leg. There were 487 cases of central type，166 cases of peripheral type，258 cases of mixed type. All the patients were implanted inferior vena cava filter under local anesthesia，then inserted an 8-14 F catheter via the femoral vein of the affected limbs to suck mechanically thrombus. Five hundred and twenty-seven cases of iliofemoral vein thrombus were inserted into sheathing canal with the help of technique of guide wire griped. The guide wire could be plugged into femoral vein，even more far，with the help of sheathing canal. Following the guide wire，a diameter-10 mm balloon catheter was used to pull the thrombus to iliac vein，with the watching of DSA，so it could be sucked from iliac vein. Before sucking thrombus，a diameter-12 mm balloon was put into the confluence of inferior vena cava and iliac vein，in case of thrombus fall off with blood flow to block inferior vena cava.
Results 　Among 911 patients，423 cases were only treated by sucking thrombus，275 cases sucking thrombus plus endovascular thrombolysis，91 cases sucking thrombus plus endovascular thrombolysis plus percutaneous transluminal angioplasty （PTA），122 cases sucking thrombus plus endovascular thrombolysis plus PTA plus stenting，the average hospital stay was 7.5 d. ① Discharge success rate：907 （99.56%） cases were successful by interventional therapy，4 （0.44%） cases were failed. Nine hundred and eleven patients were performed mechanical thrombus suction，which was 556 cases of gradeⅢ，142 cases of gradeⅡ，213 cases of gradeⅠ. Among 213 cases of gradeⅠ，there were 91 cases only underwent PTA treatment for economic reasons or advanced stage malignant tumors，122 cases underwent PTA plus stenting. The circumferences of affected limb and the differences of circumference of healthy and affected limbs knees above and below 15 cm at discharge were significantly smaller than those at admission （P＜0.01）. Twenty-seven cases underwent anticoagulation and thrombolytic therapy after operation，which occurred mild subcutaneous bleeding，gum bleeding，epistaxis，hematuria，and the symptoms were disappearance after adjusting drugs. All the patients did not appear to complications such as bleeding，vessel dissection. ② Follow-up effective rate：After 6 to 12 months follow-up，there were 714 （78.38%） cases of excellent，136 （14.92%） cases of good，57 （6.26%） cases of middle，4 （0.44%） cases of poor. After 13 to 24 months follow-up，there were 691 （76.18%） cases of excellent，151 （16.65%） cases of good，65 （7.17%） cases of middle；65 cases occurred restenosis that the PTA and stent placement was underwent again， blood flow of 58 cases completely restored，blood flow of 7 cases partly recovered，and the contrast agent didn’t retent. After 25 to 36 months follow-up，there were 681 （75.08%） cases of excellent，128 （14.11%） cases of good，98 （10.81%） cases of middle；98 cases of limb swelling were not satisfied，and the patients still had a sense of pain after walking，but the symptoms obviously improved as compared with preoperative symptoms，the patients were advised to wear stretch socks with no further interventional therapy. Conclusions　Minimally invasive therapy on lower extremity DVT can eliminate thrombus from venous cavity more early，restore the unobstructed flow instantly，preserve the function of venous valve in a greater degree. It has an advantage of minimally invasive，less complications，and notable clinic effect of short-term and medium-term follow-up.

Citation： ZHANG Xiquan,WANG Yiping,PAN Jingjing,ZHU Wei,LI Changhai,GUO Feng,DONG Ge,ZHANG Qing. Minimally Invasive Therapy in Acute Deep Venous Thrombosis of Lower Extremities. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(11): 1163-1170. doi: Copy

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5.	李晓强，段鹏飞，钱爱民，等. 介入联合手术治疗急性下肢深静脉血栓形成[J]. 中华普通外科杂志， 2006， 21(9)：660-661.
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8.	Wicky ST. Acute deep vein thrombosis and thrombolysis[J]. Tech Vasc Interv Radiol， 2009， 12(2)：148-153.
9.	邵新宏，包文. 下肢深静脉血栓手术与溶栓治疗效果的比较[J]. 中国普外基础与临床杂志， 2011， 18(12)：1309-1313.
10.	Labropoulos N， Jen J， Jen H， et al. Recurrent deep vein thrombosis：long-term incidence and natural history[J]. Ann Surg， 2010， 251(4)：749-753.
11.	Parisi R， Visonà A， Camporese G， et al. Isolated distal deep vein thrombosis：efficacy and safety of a protocol of treatment. Treatment of Isolated Calf Thrombosis (TICT) Study[J]. Int Angiol， 2009， 28(1)：68-72.
12.	Kwak HS， Han YM， Lee YS， et al. Stents in common iliac vein obstruction with acute ipsilateral deep venous thrombosis：early and late results[J]. J Vasc Interv Radiol， 2005， 16(6)：815-822.
13.	Kearon C， Kahn SR， Agnelli G， et al. Antithrombotic therapy for cenous thromboembolic disease. American college of chest Physicians evidence-based clinical rractice guidelines (8th edition)[J]. Chest， 2008， 133(6 suppl)：454S-545S.
14.	Vedantham S， Thorpe PE， Cardella JF， et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal[J]. J Vasc Interv Radiol， 2009， 20(7 Suppl)：S227-S239.
15.	Chung JW， Yoon CJ， Jung SI， et al. Acute iliofemoral deep vein thrombosis：evaluation of underlying anatomic abnormalities by spiral CT venography[J]. J Vasc Interv Radiol， 2004， 15(3)：249-256.
16.	Wells PS， Forster AJ. Thrombolysis in deep vein thrombosis：is there still an indication?[J]. Thromb Haemost， 2001， 86(1)：499-508.
17.	Mewissen MW， Seabrook GR， Meissner MH， et al. Catheter-directed thrombolysis for lower extremity deep venous thrombosis：report of a National multicenter registry[J]. Radiology， 1999， 211(1)：39-49.
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[J]. 中华普通外科杂志， 2010， 25(2)：155-157.
19.	刘素芬，何运良. Cockett综合征伴下肢深静脉血栓的治疗[J]. 临床放射学杂志， 2009， 28(3)：391-394.
20.	李天润，李选，翟国钧，等. 介入联合手术治疗急性髂股静脉血栓形成[J]. 中华普通外科杂志， 2011， 26(10)：845-848.
21.	赵堂海，王海波，郭明金，等. 取栓联合腔内血管成形术治疗急性下肢深静脉血栓形成[J]. 中华普通外科杂志， 2011， 26(3)：205-207.
22.	Raffini L， Raybagkar D， Cahill AM， et al. May-Thurner syndrome (iliac vein compression) and thrombosis in adolescents[J]. Pediatr Blood Cancer， 2006， 47(6)：834-838.
23.	Oguzkurt L， Tercan F， Ozkan U， et al. Iliac vein compression syndrome：outcome of endovascular treatment with long-term follow-up[J]. Eur J Radiol， 2008， 68(3)：487-492.
24.	Hartung O， Benmiloud F， Barthelemy P， et al. Late results of surgical venous thrombectomy with iliocaval stenting[J]. Vasc Surg， 2008， 47(2)：381-387.
25.	Raju S. Iliac vein outflow obstruction in ‘primary’ chronic venous disease[J]. Phlebolymphology， 2008， 15(1)：12-16.

1. Vedantham S， Thorpe PE， Cardella JF， et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal[J]. J Vasc Interv Radiol， 2006， 17(3)：435-448.
2. Oğuzkurt L， Ozkan U， Gülcan O， et al. Endovascular treatment of acute and subacute iliofemoral deep venous thrombosis using manual aspiration thrombectomy：long-term results of 139 patients in a single center[J]. Diagn Interv Radiol， 2012， 18(4)：410-416.
3. 罗定远，黎洪浩，龙淼云，等. 手术取栓与药物溶栓治疗急性髂股型下肢深静脉血栓形成的疗效比较[J]. 中华普通外科杂志， 2010， 25(11)：876-879.
4. 顾建平，徐克，滕皋军. 下肢深静脉血栓形成介入治疗规范的专家共识[J]. 介入放射学杂志， 2011， 20(7)：505-510.
5. 李晓强，段鹏飞，钱爱民，等. 介入联合手术治疗急性下肢深静脉血栓形成[J]. 中华普通外科杂志， 2006， 21(9)：660-661.
6. 谷涌泉，张建，齐立行，等. 急性重症下肢深静脉血栓形成的外科治疗[J]. 中华医学杂志， 2009， 89(45)：3186-3188.
7. 时德，赵渝. 下肢慢性静脉功能不全治疗的再认识[J]. 中国普外基础与临床杂志， 2009， 16(6)：421-424.
8. Wicky ST. Acute deep vein thrombosis and thrombolysis[J]. Tech Vasc Interv Radiol， 2009， 12(2)：148-153.
9. 邵新宏，包文. 下肢深静脉血栓手术与溶栓治疗效果的比较[J]. 中国普外基础与临床杂志， 2011， 18(12)：1309-1313.
10. Labropoulos N， Jen J， Jen H， et al. Recurrent deep vein thrombosis：long-term incidence and natural history[J]. Ann Surg， 2010， 251(4)：749-753.
11. Parisi R， Visonà A， Camporese G， et al. Isolated distal deep vein thrombosis：efficacy and safety of a protocol of treatment. Treatment of Isolated Calf Thrombosis (TICT) Study[J]. Int Angiol， 2009， 28(1)：68-72.
12. Kwak HS， Han YM， Lee YS， et al. Stents in common iliac vein obstruction with acute ipsilateral deep venous thrombosis：early and late results[J]. J Vasc Interv Radiol， 2005， 16(6)：815-822.
13. Kearon C， Kahn SR， Agnelli G， et al. Antithrombotic therapy for cenous thromboembolic disease. American college of chest Physicians evidence-based clinical rractice guidelines (8th edition)[J]. Chest， 2008， 133(6 suppl)：454S-545S.
14. Vedantham S， Thorpe PE， Cardella JF， et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal[J]. J Vasc Interv Radiol， 2009， 20(7 Suppl)：S227-S239.
15. Chung JW， Yoon CJ， Jung SI， et al. Acute iliofemoral deep vein thrombosis：evaluation of underlying anatomic abnormalities by spiral CT venography[J]. J Vasc Interv Radiol， 2004， 15(3)：249-256.
16. Wells PS， Forster AJ. Thrombolysis in deep vein thrombosis：is there still an indication?[J]. Thromb Haemost， 2001， 86(1)：499-508.
17. Mewissen MW， Seabrook GR， Meissner MH， et al. Catheter-directed thrombolysis for lower extremity deep venous thrombosis：report of a National multicenter registry[J]. Radiology， 1999， 211(1)：39-49.
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[J]. 中华普通外科杂志， 2010， 25(2)：155-157.
19. 刘素芬，何运良. Cockett综合征伴下肢深静脉血栓的治疗[J]. 临床放射学杂志， 2009， 28(3)：391-394.
20. 李天润，李选，翟国钧，等. 介入联合手术治疗急性髂股静脉血栓形成[J]. 中华普通外科杂志， 2011， 26(10)：845-848.
21. 赵堂海，王海波，郭明金，等. 取栓联合腔内血管成形术治疗急性下肢深静脉血栓形成[J]. 中华普通外科杂志， 2011， 26(3)：205-207.
22. Raffini L， Raybagkar D， Cahill AM， et al. May-Thurner syndrome (iliac vein compression) and thrombosis in adolescents[J]. Pediatr Blood Cancer， 2006， 47(6)：834-838.
23. Oguzkurt L， Tercan F， Ozkan U， et al. Iliac vein compression syndrome：outcome of endovascular treatment with long-term follow-up[J]. Eur J Radiol， 2008， 68(3)：487-492.
24. Hartung O， Benmiloud F， Barthelemy P， et al. Late results of surgical venous thrombectomy with iliocaval stenting[J]. Vasc Surg， 2008， 47(2)：381-387.
25. Raju S. Iliac vein outflow obstruction in ‘primary’ chronic venous disease[J]. Phlebolymphology， 2008， 15(1)：12-16.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Minimally Invasive Therapy in Acute Deep Venous Thrombosis of Lower Extremities

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