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| The analysis of clinical effect of mechanical aspiration and thrombolytic treatment foracute mixed lower extremity deep venous thrombosis |
| ZHANG Xi-quan, WANG Yi-ping, ZHU Wei, LI Chang-hai, GUO Feng, DONG Ge, ZHANG Qing |
| Department of Interventional Vascular, the 148th Hospital of Chinese People’s Liberation Army,Zibo Shandong 255300, China |
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Abstract Objective: To compare the clinical effect of mechanical aspiration and thrombolytic treatment for acute mixed lower extremity deep venous thrombosis(LEDVT). Materials and Methods: The clinical data of 458 patients with acute mixed LEDVT from April 1998 to January 2010 were reviewed. 327 patients(A group) were treated with mechanical thrombus aspiration, among which there were 113 patients combined with iliac vein compression syndrome(IVCS). PTA and stenting were used as auxiliary treatments, and all the patients received small dose of urokinase(UK) thrombolysis and heparin anticoagulation after operation. 131 patients(B group) were treated by systemic thrombolysis and anticoagulation with UK and heparin. Results: After leaving hospital, the difference of circumference 15 cm above and under the knees for bilateral limbs in group A was reduced from (10.51±7.53) cm and (5.86±3.26) cm to (1.34±1.07) cm and (0.93±0.52) cm(ｕ＝21.80, ｕ=27.00)． In Group B, the difference was reduced from (10.68±7.67) cm and (5．52±3．37) cm to (2.89±1.53) cm and (1.72±0.89) cm(ｕ＝11.39, ｕ＝12.45). Patients were followed up for an average of (46±39) months, and the circumference 15 cm under the knees was reduced to (0.53±0.42) cm in group A and (1.42±1.35) cm in group B(ｕ=7.40). The sequelae of edema, pigmentation and ulcer were 27.83％(91/327), 13.15％(43/327) and 0％ in group A, lower than 55.73％(73/131), 83.97％(110/131) and 9.16％(12/131) in group B(ｕ＝3.14, 14.52, 5.58). CDFI found in group A 90.83％ veins regained patency and 73.09％ valves had normal function, which were higher than those in group B (37.41％ and 15.27％, ｕ＝12.04, ｕ＝11.28). The follow-up effect of group A 88.99％ was obviously higher than group B 29.77％(ｕ＝12.74). There were two patients in group B who suffered life-threatening bleeding but no one in group A. Conclusion: For the treatment of acute mixed DVT, especially for protecting the normal valve function, mechanical thrombus aspiration is significantly superior to systemic thrombolysis. To prevent re-thrombosis and improve medium-term and long-term follow-up clinical effect, we should take comprehensive treatments of thrombolysis, anticoagulation, antiplatelet etc.
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Received: 14 May 2012
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2012, Vol. 23 
