大腔导管手动抽吸和经皮机械血栓清除术治疗髂静脉闭塞继发髂股静脉血栓形成的比较

背景与目的：急性髂股型深静脉血栓可导致比较严重的并发症，目前治疗方法包括导管接触性溶栓（CDT）、大腔导管手动抽吸（MAT）、经皮机械性血栓清除术（PMT）等技术，本研究比较MAT与PMT术后同期支架置入术治疗髂静脉闭塞继发髂股静脉血栓形成的疗效及安全性，为临床治疗选择提供参考。 方法：回顾性分析收治的63例髂静脉闭塞继发髂股静脉血栓患者的临床资料，其中28例行MAT治疗（MAT组），35例应用Angiojet系统行PMT治疗（PMT组），两组患者均在血栓清除术后行同期髂静脉支架置入。 结果：两组临床技术成功率均为100%。两组III级血栓清除率、24 h患肢消肿程度、术后辅助CDT例数、住院时间，所需支架的长度方面差异无统计学意义（均P>0.05）。MAT组的手术操作时间短于PMT组，但射线曝光时间长于PMT组，MAT组术中失血量低于PMT组、但尿激酶用量少于PMT组，MAT组总费用少于PMT组，差异均有统计学意义（均P<0.05）。两组均无严重并发症和不良反应发生。术后随访12~24个月，两组支架通畅率、Villalta评分差异均无统计学意义（均P>0.05）。 结论：采用MAT或AngioJet PMT急性血栓清除后，同期髂静脉支架置入治疗IFDVT，临床疗效相似且安全。相比之下，MAT无需特殊器械，花费少，操作简易，减少溶栓药物用量，是值得推荐的治疗方法。

Manual aspiration thrombectomy versus percutaneous mechanical thrombectomy in treatment of iliofemoral deep venous thrombosis caused by iliac vein occlusion

Background and Aims: Acute iliofemoral deep venous thrombosis can lead to serious complications. The techniques such as catheter-directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT) and manual aspiration thrombectomy (MAT) are currently available treatment methods. The aim of this study was to compare the efficacy and safety of MAT versus PMT followed by stent placement in treatment of patients with iliofemoral deep venous thrombosis caused by iliac vein occlusion, so as to provide the reference for clinical treatment options.  Methods: The clinical data of 63 patients undergoing treatment in the vascular surgery department for iliofemoral deep venous thrombosis caused by iliac vein occlusion were retrospectively analyzed. Among these patients, 28 cases received MAT (MAT group) and 35 cases underwent PMT with AngioJet system (PMT group). Patients in both groups underwent simultaneous stent implantation of the iliac vein after thrombectomy.  Results: The clinical technical success rates were 100% for both groups. There were no significant differences between the two groups in terms of rate of grade III thrombus clearance, degree of detumescence at 24 h. proportion of cases requiring postoperative CDT, length of hospital stay and length of the stent used (all P>0.05). In MAT group, the operative time was shorter, but the gamma exposure time was longer than those in PMT group, the intraoperative blood loss was less, but the dose of urokinase used was greater than those in PMT group, and the total hospital cost was less than that in PMT group, and all differences had statistical significance (all P<0.05). No severe complications and adverse reactions in both groups. Postoperative follow-up was conducted for 12 to 24 months, and stent patency rate and the Villalta scores showed no significant differences between the two groups (both P>0.05).    Conclusion: Acute thrombus removal using MAT or AngioJet PMT with simultaneous stent implantation of the iliac vein has the same efficacy and safety in the treatment of IFDVT. However, by comparison, MAT has the advantages of requiring no specific equipment, less costs and easy operation as well as reduced use of thrombolytic drug. So, It is a recommendable treatment method.