目的全身抗凝仍是急性下肢深静脉血栓形成(DVT)的标准,但人们对导管溶栓(CDT)及其降低血栓后综合征(PTS)发生率的潜力越来越感兴趣,导致超声加速CDT(US-CDT)的出现.迄今为止,很少有研究检查US-CDT相对于传统CDT(T-CDT)的结果。方法这是一项回顾性研究,单中心回顾了5年期间所有接受急性LEDVT治疗的患者的UST和T-CDT.根据人口统计学对患者进行分层,介绍,合并症,危险因素,和围手术期数据。结果67例患者共76条肢体接受治疗;42例患者共51条肢体接受US-CDT治疗,25例患者的25条肢接受T-CDT治疗。辅助手段包括:药物机械溶栓(n=28vs.20,p=0.04),血管成形术(n=22vs.18,p=0.11),支架(n=30vs.6,p≤0.001),和IVC过滤器插入(n=5vs.0,p=0.07)。美国和T-CDT的平均裂解时间为21±1.7和24±1.8h,分别(p=0.26)。三十(25超声波,5传统)肢体均有完整溶解。31个(22个超声波,9传统)四肢有不完全溶解。十五(4超声波,11个传统)肢体的溶解无效(p=0.002,有利于超声)。4例患者(3US-CDT,1T-CDT)在30天内复发性同侧血栓形成(p=0.60)。通过Kaplan-Meier分析,原发性通畅性之间没有显着差异,初级辅助通畅,二级通畅,再血栓形成,并在6、12和24个月时出现反复症状。结论与T-CDT相比,US-CDT不能显著改善急性LEDVT患者的中期通畅,但可显著降低急性血栓负荷。这可能有利于降低PTS的长期发病率。
Objective Systemic anticoagulation remains the standard for acute lower extremity (LE) deep venous thrombosis (DVT), but growing interest in catheter-directed thrombolysis (CDT) and its potential to reduce the incidence of post-thrombotic syndrome (PTS) has led to advent of ultrasound-accelerated CDT (US-
CDT). Few studies to date have examined the outcomes of US-
CDT against traditional
CDT (T-
CDT). Methods This is a retrospective, single-center
review of all patients treated for acute LE DVT over a five-year period with either US- and T-
CDT. Patients were stratified based on demographics, presentation, co-morbidities, risk factors, and peri-procedural data. Results Seventy-six limbs in 67 patients were treated; 51 limbs in 42 patients were treated with US-CDT, and 25 limbs in 25 patients were treated with T-CDT. Adjuncts include: pharmacomechanical thrombolysis ( n = 28 vs. 20, p = 0.04), angioplasty ( n = 22 vs. 18, p = 0.11), stenting ( n = 30 vs. 6, p ≤ 0.001), and IVC filter insertion ( n = 5 vs. 0, p = 0.07). Mean lysis times were 21 ± 1.7 and 24 ± 1.8 h for US- and T-CDT, respectively ( p = 0.26). Thirty (25 ultrasound, 5 traditional) limbs had complete lysis. Thirty-one (22 ultrasound, 9 traditional) limbs had incomplete lysis. Fifteen (4 ultrasound, 11 traditional) limbs had ineffective lysis ( p = 0.002 in favor of ultrasound). Four patients (3 US-
CDT, 1 T-
CDT) had recurrent ipsilateral thrombosis within 30 days ( p = 0.60). By Kaplan-Meier analysis, there were no significant difference between primary patency, primary-assisted patency, secondary patency, re-thrombosis, and recurrent symptoms at 6, 12, and 24 months. Conclusion US-CDT does not significantly improve mid-term patencies but results in greater acute clot burden reduction in patients with acute LE DVTs compared to T-CDT, which may be beneficial in reducing the long-term incidence of PTS.