The efficacy of AngioJet thrombectomy combined with iliac vein stenting for patients diagnosed with acute lower extremity deep venous thrombosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Tao , SUN Bo , CAO Guangxin , ZHANG Jiefeng ,  SHANG Suiyuan

Department of Vascular Surgery, Weifang People’s Hospital, Weifang, Shandong 261000, P. R. China;

Corresponding?author：

SHANG Suiyuan, Email: 1023771351@qq.com

Keywords：

deep vein thrombosis; AngioJet thrombectomy; inferior vena cava filter; iliac vein compression syndrome

DOI：

10.7507/1007-9424.202409071

Video：

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Objective To investigate the clinical efficacy of AngioJet thrombectomy combined with iliac vein stenting for patients diagnosed with acute lower extremity deep venous thrombosis (DVT) with iliac vein compression syndrome（IVCS）. Methods Between January 2021 and October 2023, a total of 64 patients with acute lower extremity DVT which performed AngioJet thrombectomy combined with iliac vein stenting in Weifang People’s Hospital were retrospectively analyzed. The changes of clinical symptoms, signs, and thrombus burden before and after operation were observed. The patency score of vein and stent, difference of thigh circumference and calf circumference diameter, venous clinical severity score (VCSS), and chronic venous insufficienc questionnaire-14item (CIVIQ-14) score were recorded pre- and postsurgically, and the patency of stent was statistically evaluated by a comprehensive assessment of the postoperative 12-month angiography. Results Operative success was achieved in all the 64 patients. The aspiration time was 300–480 s [(313±32) s], and the operative time was 80–120 min [ (97±21) min]. No complications such as bleeding and hematoma occurred after operation. The hospitalization time was 5–12 d [ (7.5±2.8) d]. After operation, the patency score of vein and stent and the difference of thigh circumference diameter decreased or reduced, and the difference were statistically significant (P<0.001). The score of VCSS decreased, score of CIVIQ-14 increased after operation (P<0.05). Color Doppler ultrasound was performed at the first, third and sixth months after operation, and anterograde venography of lower limbs was performed at the 12th month. Only one patient had thrombosis recurrence at one month after operation, and finally developed into post-thrombosis syndrome of deep veins of lower limbs after anticoagulant conservative treatment. The veins and stents of the rest patients were unobstructed. Conclusion AngioJet thrombectomy combined with iliac vein stenting, could effectively expedited clot removal, reduced limb swelling, prevented post-thrombotic syndrome recurrence and significantly improved quality of life for patients with acute lower extremity DVT.

Citation： LIU Tao, SUN Bo, CAO Guangxin, ZHANG Jiefeng, SHANG Suiyuan. The efficacy of AngioJet thrombectomy combined with iliac vein stenting for patients diagnosed with acute lower extremity deep venous thrombosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(11): 1391-1395. doi: 10.7507/1007-9424.202409071 Copy

1.	Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med, 2008, 149(10): 698-707.
2.	曾彥彰, 袁平, 何強. 導管接觸溶栓與單純抗凝治療急性近端深靜脈血栓形成的療效對比研究. 中國普外基礎與臨床雜志, 2024, 31(3): 315-319.
3.	Strijkers RH, Arnoldussen CW, Wittens CH. Validation of the LET classification. Phlebology, 2015, 30(1 Suppl): 14-19.
4.	Enden T, Haig Y, Kl?w NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a andomized controlled trial. Lancet, 2012, 379(9810): 31-38.
5.	Comerota AJ, Paolini D. Treatment of acute iliofemoral deep venous thrombosis: a strategy of thrombus removal. Eur J Vasc Endovasc Surg, 2007, 33(3): 351-360.
6.	Cakir V, Gulcu A, Akay E, et al. Use of percutaneous aspiration thrombectomy vs. anticoagulation therapy to treat acute iliofemoral venous thrombosis: 1-year follow-up results of a andomized, clinical trial. Cardiovasc Intervent Radiol, 2014, 37(4): 969-976.
7.	《血管與腔內血管外科雜志》編輯部, 下肢靜脈疾病外科治療專家協作組. AngioJet 機械血栓清除術治療急性下肢深靜脈血栓形成的專家共識(2016版). 血管與腔內血管外科雜志, 2017, 3(1): 555-558.
8.	中國醫師協會介入醫師分會, 中華醫學會放射學分會介入專業委員會, 中國靜脈介入聯盟. 下肢深靜脈血栓形成介入治療規范的專家共識(第2版). 介入放射學雜志, 2019, 28(1): 1-10.
9.	Launois R, Le Moine JG, Lozano FS, et al. Construction and international validation of CIVIQ-14 (a short form of CIVIQ-20), a new questionnaire with a stable factorial structure. Qual Life Res, 2012, 21(6): 1051-1058.
10.	Khalil E, Ozcan S. The safety and efficacy of pharmaco-mechanical thrombolysis in lower-extremity deep venous thrombosis. Cardiovasc J Afr, 2020, 31(6): 286-290.
11.	Holbrook A, Schulman S, Witt DM, et al. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis. 9^th edn: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141 (2 Suppl): e152S-e184S. doi: 10.1378/chest.11-2295.
12.	Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s Choice—European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg, 2021, 61(1): 9-82.
13.	郭相江, 薛冠華. 下肢深靜脈高負荷血栓評估及處理策略. 中國實用外科雜志, 2020, 40(5): 519-522.
14.	葉煒, 宋小軍, 劉志麗, 等. 急性下肢深靜脈血栓的血栓清除治療—CDT 還是 PMT. 血管與腔內血管外科雜志, 2017, 3(1): 559-562.
15.	Dasari TW, Pappy R, Hennebry TA. Pharmacomechanical thrombolysis of acute and chronic symptomatic deep vein thrombosis: a systematic review of literature. Angiology, 2012, 63(2): 138-145.
16.	Robertson L, McBride O, Burdess A. Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis. Cochrane Database Syst Rev, 2016, 11(11): CD011536. doi: 10.1002/14651858.CD011536.pub2.
17.	Comerota AJ, Throm RC, Mathias SD, et al. Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life. J Vasc Surg, 2000, 32(1): 130-137.
18.	杜果城, 弋文, 朱克鵬, 等. 從5年隨訪結果評價置管溶栓治療下肢深靜脈血栓形成的療效. 中國普外基礎與臨床雜志, 2021, 28(5): 601-605.
19.	Broderick C, Watson L, Armon MP. Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb. Cochrane Database Syst Rev, 2021, 1(1): CD002783. doi: 10.1002/14651858.CD002783.pub5.
20.	Lichtenberg MKW, Stahlhoff S, M?yńczak K, et al. Endovascular mechanical thrombectomy versus thrombolysis in patients with iliofemoral deep vein thrombosis—a systematic review and meta-analysis. Vasa, 2021, 50(1): 59-67.
21.	Wang CN, Deng HR. Percutaneous endovenous intervention plus anticoagulation versus anticoagulation alone for treating patients with proximal deep vein thrombosis: a meta-analysis and systematic review. Ann Vasc Surg, 2018, 49: 39-48.
22.	Vedantham S, Sista AK, Klein SJ, et al. Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol, 2014, 25(9): 1317-1325.

1. Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med, 2008, 149(10): 698-707.
2. 曾彥彰, 袁平, 何強. 導管接觸溶栓與單純抗凝治療急性近端深靜脈血栓形成的療效對比研究. 中國普外基礎與臨床雜志, 2024, 31(3): 315-319.
3. Strijkers RH, Arnoldussen CW, Wittens CH. Validation of the LET classification. Phlebology, 2015, 30(1 Suppl): 14-19.
4. Enden T, Haig Y, Kl?w NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a andomized controlled trial. Lancet, 2012, 379(9810): 31-38.
5. Comerota AJ, Paolini D. Treatment of acute iliofemoral deep venous thrombosis: a strategy of thrombus removal. Eur J Vasc Endovasc Surg, 2007, 33(3): 351-360.
6. Cakir V, Gulcu A, Akay E, et al. Use of percutaneous aspiration thrombectomy vs. anticoagulation therapy to treat acute iliofemoral venous thrombosis: 1-year follow-up results of a andomized, clinical trial. Cardiovasc Intervent Radiol, 2014, 37(4): 969-976.
7. 《血管與腔內血管外科雜志》編輯部, 下肢靜脈疾病外科治療專家協作組. AngioJet 機械血栓清除術治療急性下肢深靜脈血栓形成的專家共識(2016版). 血管與腔內血管外科雜志, 2017, 3(1): 555-558.
8. 中國醫師協會介入醫師分會, 中華醫學會放射學分會介入專業委員會, 中國靜脈介入聯盟. 下肢深靜脈血栓形成介入治療規范的專家共識(第2版). 介入放射學雜志, 2019, 28(1): 1-10.
9. Launois R, Le Moine JG, Lozano FS, et al. Construction and international validation of CIVIQ-14 (a short form of CIVIQ-20), a new questionnaire with a stable factorial structure. Qual Life Res, 2012, 21(6): 1051-1058.
10. Khalil E, Ozcan S. The safety and efficacy of pharmaco-mechanical thrombolysis in lower-extremity deep venous thrombosis. Cardiovasc J Afr, 2020, 31(6): 286-290.
11. Holbrook A, Schulman S, Witt DM, et al. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis. 9^th edn: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141 (2 Suppl): e152S-e184S. doi: 10.1378/chest.11-2295.
12. Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s Choice—European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg, 2021, 61(1): 9-82.
13. 郭相江, 薛冠華. 下肢深靜脈高負荷血栓評估及處理策略. 中國實用外科雜志, 2020, 40(5): 519-522.
14. 葉煒, 宋小軍, 劉志麗, 等. 急性下肢深靜脈血栓的血栓清除治療—CDT 還是 PMT. 血管與腔內血管外科雜志, 2017, 3(1): 559-562.
15. Dasari TW, Pappy R, Hennebry TA. Pharmacomechanical thrombolysis of acute and chronic symptomatic deep vein thrombosis: a systematic review of literature. Angiology, 2012, 63(2): 138-145.
16. Robertson L, McBride O, Burdess A. Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis. Cochrane Database Syst Rev, 2016, 11(11): CD011536. doi: 10.1002/14651858.CD011536.pub2.
17. Comerota AJ, Throm RC, Mathias SD, et al. Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life. J Vasc Surg, 2000, 32(1): 130-137.
18. 杜果城, 弋文, 朱克鵬, 等. 從5年隨訪結果評價置管溶栓治療下肢深靜脈血栓形成的療效. 中國普外基礎與臨床雜志, 2021, 28(5): 601-605.
19. Broderick C, Watson L, Armon MP. Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb. Cochrane Database Syst Rev, 2021, 1(1): CD002783. doi: 10.1002/14651858.CD002783.pub5.
20. Lichtenberg MKW, Stahlhoff S, M?yńczak K, et al. Endovascular mechanical thrombectomy versus thrombolysis in patients with iliofemoral deep vein thrombosis—a systematic review and meta-analysis. Vasa, 2021, 50(1): 59-67.
21. Wang CN, Deng HR. Percutaneous endovenous intervention plus anticoagulation versus anticoagulation alone for treating patients with proximal deep vein thrombosis: a meta-analysis and systematic review. Ann Vasc Surg, 2018, 49: 39-48.
22. Vedantham S, Sista AK, Klein SJ, et al. Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol, 2014, 25(9): 1317-1325.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The efficacy of AngioJet thrombectomy combined with iliac vein stenting for patients diagnosed with acute lower extremity deep venous thrombosis

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