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Abstract：
This study was designed to assess the optimal access route for the endovascular treatment of acute lower extremity deep vein thrombosis. This was a retrospective analysis of patients with acute lower extremity deep venous thrombosis who underwent endovascular treatment from February 2009 to December 2020. Patients underwent non-direct calf deep vein puncture (NDCDVP) from February 2009 to December 2011 and direct calf deep vein puncture (DCDVP) from January 2012 to December 2020. Catheter directed thrombolysis (CDT) was used to treat all patients in the NDCDVP group, whereas patients in the DCDVP group were treated with CDT or the AngioJet rhyolitic thrombectomy system. In patients exhibiting iliac vein compression syndrome, the iliac vein was dilated and implanted with a stent. Technical success rates and perioperative complication rates were compared between these two treatment groups. The NDCDVP group included 83 patients (40 males, 43 females) with a mean age of 55 ± 16 years, while the DCDVP group included 487 patients (231 males. 256 females) with a mean age of 56 ± 15 years. No significant differences were observed between these groups with respect to any analyzed clinical characteristics. The technical success rates in the NDCDVP and DCDVP groups were 96.4 and 98.2%, respectively (P > 0.05). In the NDCDVP group, the small saphenous vein (SSV)or great saphenous vein (GSV)were the most common access routes (77.1%, 64/83), whereas the anterior tibial vein (ATV) was the most common access route in the DCDVP group (78.0%, 380/487), followed by the posterior tibial vein (PTV) and peroneal vein (PV)(15.6% and 6.4%, respectively). Relative to the NDCDVP group, more patients in the DCDVP group underwent the removal of deep vein clots below the knee (7.2% [6/83] vs. 24.2% [118/487], P < 0.001). Moreover, relative to the NDCDVP group, significantly lower complication rates were evident in the DCDVP group (local infection: 10.8% vs. 0.4%, P < 0.001; local hematoma: 15.7% vs. 1.0%, P < 0.001). The position change rate was also significantly lower in the DCDVP group relative to the NDCDVP group (0% [0/487] vs. 60.2% [50/83], P < 0.001). The calf deep veins (CDVs) represent a feasible and safe access route for the endovascular treatment of lower extremity deep vein thrombosis.
摘要：
本研究旨在评估急性下肢深静脉血栓形成血管内治疗的最佳入路。回顾性分析2009年2月至2020年12月接受血管内治疗的急性下肢深静脉血栓形成患者。患者于2009年2月至2011年12月进行了非直接小腿深静脉穿刺（NDCDVP），并于2012年1月至2020年12月进行了直接小腿深静脉穿刺（DCDVP）。NDCDVP组的所有患者均采用导管溶栓(CDT)治疗,而DCDVP组患者接受CDT或AngioJet流纹性血栓切除系统治疗。表现为髂静脉压迫综合征的患者,髂静脉扩张并植入支架.比较两组患者的技术成功率及围手术期并发症发生率。NDCDVP组包括83例患者(40例男性，43名女性），平均年龄55±16岁，而DCDVP组包括487例患者（男性231例。256名女性），平均年龄为56±15岁。关于任何分析的临床特征,在这些组之间没有观察到显著差异。NDCDVP和DCDVP组的技术成功率分别为96.4％和98.2％，分别为(P>0.05)。在NDCDVP组中，小隐静脉(SSV)或大隐静脉(GSV)是最常见的入路(77.1%,64/83)，而在DCDVP组中,胫骨前静脉(ATV)是最常见的通路(78.0%,380/487），其次是胫后静脉（PTV）和腓骨静脉（PV）（15.6％和6.4％，分别)。相对于NDCDVP组，DCDVP组的更多患者接受了膝盖以下深静脉凝块的去除(7.2%[6/83]vs.24.2%[118/487]，P<0.001)。此外，相对于NDCDVP组，DCDVP组的并发症发生率明显较低（局部感染：10.8％vs.0.4%,P<0.001；局部血肿：15.7%vs.1.0%，P<0.001)。DCDVP组的位置变化率也显著低于NDCDVP组(0%[0/487]vs.60.2%[50/83]，P<0.001)。小腿深静脉（CDV）是下肢深静脉血栓形成血管内治疗的可行且安全的通路。
