Meta-analysis of the early and mid-term efficacy of AngioJet mechanical thrombectomy andcatheter-directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TAN Qiang , CHEN Hang , CHEN Jingquan , ZHENG Guoxue ,  ZHENG Jianghua

Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding?author：

ZHENG Jianghua, Email: zhengjianghua@126.com

Keywords：

acute lower extremity deep venous thrombosis; AngioJet mechanical thrombectomy; catheter-directed thrombolysis; meta-analysis

DOI：

10.7507/1007-9424.202008073

Video：

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Objective To systematically evaluated the efficacy of AngioJet mechanical thrombectomy and catheter-directed thrombolysis (CDT) in the treatment of acute lower extremity deep venous thrombosis (LEDVT).Methods According to the retrieval strategy of Cochrane collaboration network, the relevant literatures in CNKI, WangFang, VIP, CBM, PubMed, Embase, Cochrane Library, Web of Science at home and abroad up to March 25, 2020 were collected, and the meta analysis was performed by using Review Manager 5.3 software.Results A total of 20 observational studies were included in the meta analysis. The total number of patients was 1 566, which 799 cases in the AngioJet group and 767 cases in the CDT group. The results showed that the AngioJet group had a higher patency rate of deep vein ［MD=11.34, 95%CI (6.16, 16.51), P<0.000 1］, lower or shorter Villalta score ［MD=–1.90, 95%CI (–2.71, –1.10), P<0.000 01］, incidence of post-thrombotic syndrome［PTS, OR=0.42, 95%CI (0.23, 0.77), P=0.005］, rate of clot reduction grade Ⅰ events ［OR=0.40, 95%CI (0.24, 0.67), P=0.000 5］, incidence of bleeding complication ［OR=0.32, 95%CI (0.21, 0.49), P<0.000 01］, and hospital stay ［MD=–2.96, 95%CI (–3.69, –2.22), P<0.000 01］.Conclusions In the early efficacy, AngioJet mechanical thrombectomy has better patency rate of deep vein and thrombolysis, shorter hospital stay, and lower risk of bleeding than CDT. In the mid-term effect, AngioJet mechanical thrombectomy could reduce the incidence and the severity of PTS.

Citation： TAN Qiang, CHEN Hang, CHEN Jingquan, ZHENG Guoxue, ZHENG Jianghua. Meta-analysis of the early and mid-term efficacy of AngioJet mechanical thrombectomy andcatheter-directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(5): 610-618. doi: 10.7507/1007-9424.202008073 Copy

1.	Law Y, Chan YC, Cheng SWK. Epidemiological updates of venous thromboembolism in a Chinese population. Asian J Surg, 2018, 41(2): 176-182.
2.	Kearon C. Natural history of venous thromboembolism. Circulation, 2003, 107(23 Suppl 1): I22-I30.
3.	Bond RT, Cohen JM, Comerota A, et al. Surgical treatment of moderate-to-severe post-thrombotic syndrome. Ann Vasc Surg, 2013, 27(2): 242-258.
4.	Diniz J, Coelho A, Mansilha A. Endovascular treatment of iliofemoral deep venous thrombosis: is there enough evidence to support it? A systematic review with meta-analysis. Int Angiol, 2020, 39(2): 93-104.
5.	Huang CY, Hsu HL, Kuo TT, et al. Percutaneous pharmacomechanical thrombectomy offers lower risk of post-thrombotic syndrome than catheter-directed thrombolysis in patients with acute deep vein thrombosis of the lower limb. Ann Vasc Surg, 2015, 29(5): 995-1002.
6.	Kim HS, Patra A, Paxton BE, et al. Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis: clinical and economic outcomes. J Vasc Interv Radiol, 2006, 17(7): 1099-1104.
7.	Kuo TT, Huang CY, Hsu CP, et al. Catheter-directed thrombolysis and pharmacomechanical thrombectomy improve midterm outcome in acute iliofemoral deep vein thrombosis. J Chin Med Assoc, 2017, 80(2): 72-79.
8.	Lin PH, Zhou W, Dardik A, et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg, 2006, 192(6): 782-788.
9.	Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg, 1995, 21(4): 635-645.
10.	Wik HS, Ghanima W, Sandset PM, et al. Scoring systems for postthrombotic syndrome. Semin Thromb Hemost, 2017, 43(5): 500-504.
11.	Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10(3): D142.
12.	Zou JB, Zhang XF, Wang J, et al. The therapeutic efficacy of danhong injection combined with percutaneous coronary intervention in acute coronary syndrome: a systematic review and meta-analysis. Front Pharmacol, 2018, 9: 550.
13.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
14.	Tang T, Chen L, Chen J, et al. Pharmacomechanical thrombectomy versus catheter-directed thrombolysis for iliofemoral deep vein thrombosis: a meta-analysis of clinical trials. Clin Appl Thromb Hemost, 2019, 25: 1076029618821190.
15.	任偉強, 徐樹彬, 曹莉明, 等. 機械血栓清除治療下肢深靜脈血栓臨床效果觀察. 臨床誤診誤治, 2019, 32(11): 54-59.
16.	尹孝亮, 郎德海, 王迪. 經皮機械血栓清除治療急性髂股靜脈血栓形成患者療效觀察. 浙江大學學報(醫學版), 2018, 47(6): 588-594.
17.	趙親明, 許中友. Angiojet機械吸栓與置管溶栓在急性髂股靜脈血栓治療中的療效對比. 現代實用醫學, 2019, 31(5): 617-619.
18.	劉磊, 馮家煊, 王宏飛, 等. 下肢深靜脈血栓形成的AngioJet機械吸栓與置管溶栓的對比研究. 中華血管外科雜志, 2016, 1(1): 22-25.
19.	宋進華, 何旭, 樓文勝, 等. AngioJet血栓抽吸裝置治療急性髂股靜脈血栓形成. 中華普通外科雜志, 2018, 33(2): 109-113.
20.	趙宇, 朱兆紅, 秦金保, 等. 導管接觸溶栓與機械輔助吸栓治療急性髂股靜脈血栓的對比研究. 現代生物醫學進展, 2017, 17(18): 3486-3489.
21.	Yin SW, Guo LW, Bian L, et al. Evaluation of percutaneous mechanical thrombectomy via the angiojet system combined with catheter-directed thrombolysis for the treatment of symptomatic lower extremity deep venous thrombosis. Ann Vasc Surg, 2020, 65: 66-71.
22.	Zhu J, Ni CF, Dai ZY, et al. A case-controlled study on AngioJet rheolytic thrombectomy and catheter-directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis. Vascular, 2020, 28(2): 177-182.
23.	高鋒利, 王克華, 茍偉, 等. 經皮腔內機械藥物血栓清除術與導管接觸溶栓治療急性深靜脈血栓形成的早期對照研究. 寧夏醫學雜志, 2019, 41(9): 804-806.
24.	韓松. 單純置管溶栓與機械性血栓清除治療下肢深靜脈血栓的療效評價. 蘇州大學, 2018.
25.	韓新強. 流變力學血栓清除系統在下肢深靜脈血栓治療中的應用研究及相關問題探討. 濟南: 山東大學, 2017.
26.	黃寶駿, 楊澄宇, 駱曦圖, 等. Angiojet機械吸栓聯合接觸性溶栓治療下肢深靜脈血栓的近期療效. 廣東醫學, 2019, 40(3): 366-369.
27.	李克偉. 藥物機械偶聯式血栓清除術治療急性下肢深靜脈血栓形成的臨床研究. 蘇州: 蘇州大學, 2016.
28.	李明澤, 梁黎, 宋威, 等. 經頸靜脈AngioJet消融聯合置管溶栓治療左下肢深靜脈血栓. 實用放射學雜志, 2019, 35(12): 1996-2001.
29.	毛茅, 李春孟. AngioJet血栓抽吸系統治療下肢深靜脈血栓的效果觀察. 浙江醫學, 2018, 40(24): 2698-2700.
30.	嚴金. AngioJet機械血栓清除術與置管溶栓治療急性下肢深靜脈血栓形成的臨床對比研究. 浙江大學, 2018.
31.	趙健, 谷巖, 張晶, 等. AngioJet機械血栓清除治療急性下肢深靜脈血栓形成. 中國中西醫結合外科雜志, 2018, 24(6): 776-779.
32.	Prandoni P, Lensing AW, Prins MH, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med, 2004, 141(4): 249-256.
33.	Du GC, Zhang MC, Zhao JC. Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis. Vasa, 2015, 44(3): 195-202.
34.	Garcia MJ, Lookstein R, Malhotra R, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: Final report of the Prospective Multicenter PEARL (Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths) Registry. J Vasc Interv Radiol, 2015, 26(6): 777-785.

1. Law Y, Chan YC, Cheng SWK. Epidemiological updates of venous thromboembolism in a Chinese population. Asian J Surg, 2018, 41(2): 176-182.
2. Kearon C. Natural history of venous thromboembolism. Circulation, 2003, 107(23 Suppl 1): I22-I30.
3. Bond RT, Cohen JM, Comerota A, et al. Surgical treatment of moderate-to-severe post-thrombotic syndrome. Ann Vasc Surg, 2013, 27(2): 242-258.
4. Diniz J, Coelho A, Mansilha A. Endovascular treatment of iliofemoral deep venous thrombosis: is there enough evidence to support it? A systematic review with meta-analysis. Int Angiol, 2020, 39(2): 93-104.
5. Huang CY, Hsu HL, Kuo TT, et al. Percutaneous pharmacomechanical thrombectomy offers lower risk of post-thrombotic syndrome than catheter-directed thrombolysis in patients with acute deep vein thrombosis of the lower limb. Ann Vasc Surg, 2015, 29(5): 995-1002.
6. Kim HS, Patra A, Paxton BE, et al. Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis: clinical and economic outcomes. J Vasc Interv Radiol, 2006, 17(7): 1099-1104.
7. Kuo TT, Huang CY, Hsu CP, et al. Catheter-directed thrombolysis and pharmacomechanical thrombectomy improve midterm outcome in acute iliofemoral deep vein thrombosis. J Chin Med Assoc, 2017, 80(2): 72-79.
8. Lin PH, Zhou W, Dardik A, et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg, 2006, 192(6): 782-788.
9. Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg, 1995, 21(4): 635-645.
10. Wik HS, Ghanima W, Sandset PM, et al. Scoring systems for postthrombotic syndrome. Semin Thromb Hemost, 2017, 43(5): 500-504.
11. Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10(3): D142.
12. Zou JB, Zhang XF, Wang J, et al. The therapeutic efficacy of danhong injection combined with percutaneous coronary intervention in acute coronary syndrome: a systematic review and meta-analysis. Front Pharmacol, 2018, 9: 550.
13. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
14. Tang T, Chen L, Chen J, et al. Pharmacomechanical thrombectomy versus catheter-directed thrombolysis for iliofemoral deep vein thrombosis: a meta-analysis of clinical trials. Clin Appl Thromb Hemost, 2019, 25: 1076029618821190.
15. 任偉強, 徐樹彬, 曹莉明, 等. 機械血栓清除治療下肢深靜脈血栓臨床效果觀察. 臨床誤診誤治, 2019, 32(11): 54-59.
16. 尹孝亮, 郎德海, 王迪. 經皮機械血栓清除治療急性髂股靜脈血栓形成患者療效觀察. 浙江大學學報(醫學版), 2018, 47(6): 588-594.
17. 趙親明, 許中友. Angiojet機械吸栓與置管溶栓在急性髂股靜脈血栓治療中的療效對比. 現代實用醫學, 2019, 31(5): 617-619.
18. 劉磊, 馮家煊, 王宏飛, 等. 下肢深靜脈血栓形成的AngioJet機械吸栓與置管溶栓的對比研究. 中華血管外科雜志, 2016, 1(1): 22-25.
19. 宋進華, 何旭, 樓文勝, 等. AngioJet血栓抽吸裝置治療急性髂股靜脈血栓形成. 中華普通外科雜志, 2018, 33(2): 109-113.
20. 趙宇, 朱兆紅, 秦金保, 等. 導管接觸溶栓與機械輔助吸栓治療急性髂股靜脈血栓的對比研究. 現代生物醫學進展, 2017, 17(18): 3486-3489.
21. Yin SW, Guo LW, Bian L, et al. Evaluation of percutaneous mechanical thrombectomy via the angiojet system combined with catheter-directed thrombolysis for the treatment of symptomatic lower extremity deep venous thrombosis. Ann Vasc Surg, 2020, 65: 66-71.
22. Zhu J, Ni CF, Dai ZY, et al. A case-controlled study on AngioJet rheolytic thrombectomy and catheter-directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis. Vascular, 2020, 28(2): 177-182.
23. 高鋒利, 王克華, 茍偉, 等. 經皮腔內機械藥物血栓清除術與導管接觸溶栓治療急性深靜脈血栓形成的早期對照研究. 寧夏醫學雜志, 2019, 41(9): 804-806.
24. 韓松. 單純置管溶栓與機械性血栓清除治療下肢深靜脈血栓的療效評價. 蘇州大學, 2018.
25. 韓新強. 流變力學血栓清除系統在下肢深靜脈血栓治療中的應用研究及相關問題探討. 濟南: 山東大學, 2017.
26. 黃寶駿, 楊澄宇, 駱曦圖, 等. Angiojet機械吸栓聯合接觸性溶栓治療下肢深靜脈血栓的近期療效. 廣東醫學, 2019, 40(3): 366-369.
27. 李克偉. 藥物機械偶聯式血栓清除術治療急性下肢深靜脈血栓形成的臨床研究. 蘇州: 蘇州大學, 2016.
28. 李明澤, 梁黎, 宋威, 等. 經頸靜脈AngioJet消融聯合置管溶栓治療左下肢深靜脈血栓. 實用放射學雜志, 2019, 35(12): 1996-2001.
29. 毛茅, 李春孟. AngioJet血栓抽吸系統治療下肢深靜脈血栓的效果觀察. 浙江醫學, 2018, 40(24): 2698-2700.
30. 嚴金. AngioJet機械血栓清除術與置管溶栓治療急性下肢深靜脈血栓形成的臨床對比研究. 浙江大學, 2018.
31. 趙健, 谷巖, 張晶, 等. AngioJet機械血栓清除治療急性下肢深靜脈血栓形成. 中國中西醫結合外科雜志, 2018, 24(6): 776-779.
32. Prandoni P, Lensing AW, Prins MH, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med, 2004, 141(4): 249-256.
33. Du GC, Zhang MC, Zhao JC. Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis. Vasa, 2015, 44(3): 195-202.
34. Garcia MJ, Lookstein R, Malhotra R, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: Final report of the Prospective Multicenter PEARL (Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths) Registry. J Vasc Interv Radiol, 2015, 26(6): 777-785.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Meta-analysis of the early and mid-term efficacy of AngioJet mechanical thrombectomy andcatheter-directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis

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