背景:有效治疗上肢深静脉血栓形成(UEDVT)对于预防进一步的并发症至关重要。各种治疗方法,包括经皮机械血栓切除术(PMT),导管溶栓(CDT),减压手术,和静脉成形术建议用于UEDVT。然而,目前尚无前瞻性研究支持这些治疗.这项研究回顾了我们对急性原发性UEDVT患者进行CDT和球囊静脉成形术的经验。
方法:我们纳入了2020年1月至2021年6月诊断为急性UEDVT的所有患者。由于恶性肿瘤等次要原因而导致UEDVT的受试者,留置导管,或引线被排除在外。通过肱静脉通路进行CDT,使用灌注导管,和rt-PA管理。如果CDT后治疗段仍有狭窄,则进行球囊静脉成形术。在静脉诊所对患者进行随访,了解上肢的任何体征和症状以及生活方式的改变。出院后12个月进行随访超声检查。
结果:研究中纳入了12名患者,平均年龄为41.08±14.0岁。CDT的平均持续时间为25.00±10.56h。所有患者都有剩余的闭塞,其中7人仍有50%以上的狭窄。然而,球囊静脉成形术后,无患者出现明显狭窄(超过50%)。两种手术后均无严重并发症。患者入院后平均随访12个月,平均抗凝维持时间为10.73±5.77个月。只有一名患者的目标肢体反复出现症状,需要进行减压手术,而其余的在他们治疗的四肢没有症状。入院期间或随访期间均未出现肺栓塞(PE)。没有因任何原因再次入院的证据。术后12个月患者的上肢彩色多普勒超声检查显示8例静脉血流正常,无明显狭窄(66.7%),4例(33.3%)患者的目标静脉通畅部分正常。
结论:CDT后再进行球囊静脉成形术可能是某些急性原发性UEDVT患者的有效治疗方法,提供理想的长期结果,并可能避免短期或长期减压手术的需要。
Effective treatment of upper extremity deep vein thrombosis (UEDVT) is crucial to prevent further complications. Various treatments, including percutaneous mechanical thrombectomy (PMT), catheter-directed thrombolysis (CDT), decompression surgery, and venoplasty are suggested for UEDVT. However, no prospective study has yet favored any of these treatments. This study presents a review of our experience with CDT followed by balloon venoplasty in patients with acute primary UEDVT.
We enrolled all patients diagnosed with acute UEDVT from January 2020 to June 2021. Subjects with UEDVT due to secondary causes like malignancies, indwelling catheters, or leads were excluded. CDT was performed through brachial vein access, using a perfusion catheter, and rt-PA administration. Balloon venoplasty was performed if the treated segment had remaining stenosis after CDT. Patients were followed up at the vein clinic for any signs and symptoms in the upper extremity and lifestyle changes. Follow-up ultrasonography was done 12 months after discharge.
Twelve patients with a mean age of 41.08 ± 14.0 years were included in the study. The mean duration of CDT was 25.00 ± 10.56 h. After CDT, all patients had remaining occlusions, with seven having more than 50% remaining stenosis. However, after balloon venoplasty, no patient had significant (more than 50%) stenosis. There was no serious complication after both procedures. Patients were followed up for a mean duration of twelve months after their admission, with a mean time of maintenance anticoagulation was 10.73 ± 5.77 months. Only one patient had recurrent symptoms in his target limb which required a decompression surgery, while the rest were free of symptoms in their treated extremity. No subject developed pulmonary emboli (PE) during admission or the follow-up period. There was no evidence of hospital readmission for any reason. Upper extremity color-doppler sonography of the patients at twelve months after their procedure showed normal venous flow without any significant stenosis in 8 (66.7%), and partially normal flow with patent target vein in 4 (33.3%) patients.
CDT followed by balloon venoplasty may be an effective treatment for selected patients with acute primary UEDVT, providing desirable long-term results and potentially avoiding the need for decompression surgery in the short or long term.