Abstract：
OBJECTIVE: To examine the efficacy of antegrade and retrograde approaches with the AngioJet thrombectomy device for the treatment of acute lower limb deep vein thrombosis (DVT) and to evaluate the necessity of filter placement.
METHODS: The clinical data of patients with acute lower limb DVT treated with the AngioJet device from January 2021 to June 2023 were retrospectively analyzed. The patients were divided into the antegrade and retrograde treatment groups according to the surgical approach and the direction of valve opening. The thrombosis interception rate of the filter, incidence of pulmonary embolism (PE), thrombectomy effectiveness, venous obstruction rate, and thrombosis recurrence rate of each treatment group were evaluated. In addition, factors affecting patency were analyzed.
RESULTS: AngioJet was employed for 84 patients with acute lower limb DVT, treating a total of 88 limbs. The thrombosis interception rate of the filter was 35.7% (30 patients). The incidence of new PE or PE exacerbation was 6.0% (5 patients), and a filter retrieval rate of 97.6% (82 patients) was detected. Thrombus removal of grade III occurred in 35 (64.8%) of the 54 limbs (61.4%) in the antegrade treatment group, versus 13 (38.2%) of the 34 limbs (38.6%) in the retrograde treatment group (P<0.05). At 3 months, venous patency and bleeding events involved 52 (96.3%) and 4 (7.4%) limbs in the antegrade treatment group, respectively, versus 29 (85.3%) and 2 (5.9%) in the retrograde treatment group, respectively (P>0.05). Regression analysis was performed to determine factors that may affect 3-month patency in both groups. Statistically significant linear relationships were found between 3-month patency and thrombus removal rate [OR=0.546 (0.326, 0.916)], thrombus formation time [OR=1.018 (1.002, 1.036)], and preoperative thrombosis score [OR=1.012 (1.002, 1.022)] in the antegrade treatment group, as well as thrombus removal rate [0.473 (0.229, 0.977)] in the retrograde treatment group. In regression analysis of factors affecting patency in both groups and VCSS/Villalta score, a statistically significant linear relationship was found between thrombus formation time and VCSS score in the antegrade treatment group [0.576 (0.467, 0.710)].
CONCLUSIONS: Both antegrade and retrograde approaches are safe and effective for the treatment of acute lower limb DVT. There are no differences in 3-month deep vein patency and post-thrombotic syndrome (PTS) incidence rates. Individuals with acute lower limb DVT are at high risk of thrombus shedding after treatment with AngioJet thrombectomy, and placement of a vena cava filter (VCF) is recommended for effective interception.
METHODS: The clinical data of patients with acute lower limb DVT treated with the AngioJet device from January 2021 to June 2023 were retrospectively analyzed. The patients were divided into the antegrade and retrograde treatment groups according to the surgical approach and the direction of valve opening. The thrombosis interception rate of the filter, incidence of pulmonary embolism (PE), thrombectomy effectiveness, venous obstruction rate, and thrombosis recurrence rate of each treatment group were evaluated. In addition, factors affecting patency were analyzed.
RESULTS: AngioJet was employed for 84 patients with acute lower limb DVT, treating a total of 88 limbs. The thrombosis interception rate of the filter was 35.7% (30 patients). The incidence of new PE or PE exacerbation was 6.0% (5 patients), and a filter retrieval rate of 97.6% (82 patients) was detected. Thrombus removal of grade III occurred in 35 (64.8%) of the 54 limbs (61.4%) in the antegrade treatment group, versus 13 (38.2%) of the 34 limbs (38.6%) in the retrograde treatment group (P<0.05). At 3 months, venous patency and bleeding events involved 52 (96.3%) and 4 (7.4%) limbs in the antegrade treatment group, respectively, versus 29 (85.3%) and 2 (5.9%) in the retrograde treatment group, respectively (P>0.05). Regression analysis was performed to determine factors that may affect 3-month patency in both groups. Statistically significant linear relationships were found between 3-month patency and thrombus removal rate [OR=0.546 (0.326, 0.916)], thrombus formation time [OR=1.018 (1.002, 1.036)], and preoperative thrombosis score [OR=1.012 (1.002, 1.022)] in the antegrade treatment group, as well as thrombus removal rate [0.473 (0.229, 0.977)] in the retrograde treatment group. In regression analysis of factors affecting patency in both groups and VCSS/Villalta score, a statistically significant linear relationship was found between thrombus formation time and VCSS score in the antegrade treatment group [0.576 (0.467, 0.710)].
CONCLUSIONS: Both antegrade and retrograde approaches are safe and effective for the treatment of acute lower limb DVT. There are no differences in 3-month deep vein patency and post-thrombotic syndrome (PTS) incidence rates. Individuals with acute lower limb DVT are at high risk of thrombus shedding after treatment with AngioJet thrombectomy, and placement of a vena cava filter (VCF) is recommended for effective interception.
摘要：
目的：探讨AngioJet取栓装置顺行和逆行入路治疗急性下肢深静脉血栓形成（DVT）的疗效，并评价滤器置入的必要性。
方法：回顾性分析2021年1月至2023年6月接受AngioJet装置治疗的急性下肢DVT患者的临床资料。根据手术入路和瓣膜开放方向将患者分为顺行和逆行治疗组。过滤器的血栓截留率，肺栓塞（PE）的发生率，血栓切除术的有效性，静脉阻塞率,评价各治疗组血栓复发率。此外,分析影响通畅性的因素。
结果：AngioJet用于84例急性下肢DVT患者，共治疗88条肢体。滤器的血栓截留率为35.7%(30例)。新PE或PE加重的发生率为6.0％（5例），检测到过滤器检索率为97.6%(82例)。顺行治疗组54条肢体(61.4%)中35条(64.8%)发生III级血栓清除,逆行治疗组34条肢体中的13条（38.2％）（38.6％）（P<0.05）。3个月时,顺行治疗组的静脉通畅和出血事件涉及52条(96.3%)和4条(7.4%)肢体,分别,逆行治疗组29例（85.3%）和2例（5.9%），分别为(P>0.05)。进行回归分析以确定可能影响两组3个月通畅性的因素。3个月通畅率与血栓清除率之间存在显著的线性关系[OR=0.546(0.326,0.916)]。血栓形成时间[OR=1.018(1.002,1.036)]，顺行治疗组和术前血栓评分[OR=1.012(1.002,1.022)],以及逆行治疗组的血栓去除率[0.473（0.229，0.977）]。在影响两组通畅性和VCSS/Villalta评分的因素的回归分析中，顺行治疗组的血栓形成时间和VCSS评分之间存在统计学显著的线性关系[0.576(0.467,0.710)].
结论：顺行和逆行两种方法治疗急性下肢DVT均安全有效。3个月深静脉通畅率和血栓后综合征（PTS）发生率无差异。急性下肢DVT患者在血管喷射血栓切除术治疗后有血栓脱落的高风险,建议放置腔静脉过滤器（VCF）以进行有效的拦截。
方法：回顾性分析2021年1月至2023年6月接受AngioJet装置治疗的急性下肢DVT患者的临床资料。根据手术入路和瓣膜开放方向将患者分为顺行和逆行治疗组。过滤器的血栓截留率，肺栓塞（PE）的发生率，血栓切除术的有效性，静脉阻塞率,评价各治疗组血栓复发率。此外,分析影响通畅性的因素。
结果：AngioJet用于84例急性下肢DVT患者，共治疗88条肢体。滤器的血栓截留率为35.7%(30例)。新PE或PE加重的发生率为6.0％（5例），检测到过滤器检索率为97.6%(82例)。顺行治疗组54条肢体(61.4%)中35条(64.8%)发生III级血栓清除,逆行治疗组34条肢体中的13条（38.2％）（38.6％）（P<0.05）。3个月时,顺行治疗组的静脉通畅和出血事件涉及52条(96.3%)和4条(7.4%)肢体,分别,逆行治疗组29例（85.3%）和2例（5.9%），分别为(P>0.05)。进行回归分析以确定可能影响两组3个月通畅性的因素。3个月通畅率与血栓清除率之间存在显著的线性关系[OR=0.546(0.326,0.916)]。血栓形成时间[OR=1.018(1.002,1.036)]，顺行治疗组和术前血栓评分[OR=1.012(1.002,1.022)],以及逆行治疗组的血栓去除率[0.473（0.229，0.977）]。在影响两组通畅性和VCSS/Villalta评分的因素的回归分析中，顺行治疗组的血栓形成时间和VCSS评分之间存在统计学显著的线性关系[0.576(0.467,0.710)].
结论：顺行和逆行两种方法治疗急性下肢DVT均安全有效。3个月深静脉通畅率和血栓后综合征（PTS）发生率无差异。急性下肢DVT患者在血管喷射血栓切除术治疗后有血栓脱落的高风险,建议放置腔静脉过滤器（VCF）以进行有效的拦截。
