逆行置管溶栓治疗下肢深静脉血栓的疑虑

目的探讨逆行置管溶栓治疗下肢深静脉血栓的有效性和弊端。方法纳入南京市第一医院介入血管科2010年1月至2017年12月首次发现急性下肢深静脉血栓的患者共213例,其中逆行置管溶栓(CDT)组(150例),单纯抗凝组(63例)。比较两组血栓清除率、6个月的髂股静脉通畅度、12个月PTS情况、静脉瓣膜反流以及生活质量评分。结果CDT组对于髂静脉血栓清除效果明显优于单纯抗凝(P=0.011),但对于股腘静脉血栓与单纯抗凝无差异(P>0.05)。逆行置管溶栓对于股总静脉血栓的效果在中央型优于混和型(P<0.0001)。相应的,CDT组6个月的髂静脉通畅率高于单纯抗凝组(P=0.002),而股静脉通畅率两组间无差异(P>0.05)。CDT组PTS发生率以及重度PTS的发生率均低于抗凝组(P<0.0001),但轻中度PTS发生率两组间无明显差异(P≥0.05)。CDT组12个月的静脉瓣膜反流情况与抗凝组相似(P>0.05),但生活质量要高于抗凝组(P<0.0001)。结论逆行置管溶栓治疗下肢深静脉血栓对于髂静脉血栓有一定优势,但由于置管困难、对静脉瓣膜损伤等原因,对于累及股腘静脉的血栓,如无特殊情况,建议将逆行置管溶栓作为次选方案。

Doubts about retrograde catheter-directed thrombolysis in the treatment of deep venous thrombosis

ObjectiveTo investigate the efficacy and disadvantages of retrograde catheter-directed thrombolysis in the treatment of deep venous thrombosis (DVT). MethodsA total of 213 patients with acute lower extremity DVT from January 2010 to December 2017 were retrospective analysed, including retrograde catheter-directed thrombolysis (CDT) group (n=150) and anticoagulation alone group (n=63). Thrombus clearance rate, iliofemoral vein patency at 6 months, post-thrombotic syndrome (PTS) at 12 months, venous valvular regurgitation and quality of life scores were compared between the two groups. ResultsIn CDT group, the clearance rate of iliac vein thrombosis was significantly better than that of anticoagulation alone (P=0.011), but there was no difference in the clearance rate of femoral and popliteal vein thrombosis (P>0.05). The effect of retrograde CDT on common femoral vein thrombosis was better in iliofemoral DVT than that in popliteal to iliac DVT. Accordingly, the patency rate of iliac vein at 6 months in CDT group was higher than that in anticoagulation group (P=0.002), but there was no difference in patency rate of femoral vein between the two groups. The incidence of PTS and severe PTS in the CDT group was lower than that in the anticoagulation group (P<0.0 001), but there was no significant difference in the incidence of mild to moderate PTS between the two groups (P>0.0 001). The venous valvular regurgitation in the CDT group was similar to that in the anticoagulation group at 12 months, but the quality of life in the CDT group was higher than that in the anticoagulation group (P<0.0 001). ConclusionsRetrograde CDT has a certain advantage for iliac venous thrombosis. However, due to the difficulty of catheterization, venous valve injury and other reasons, if there is no special situation, retrograde CDT is recommended as the second choice for thrombosis involving the femoral and popliteal vein.