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Objective:To investigate the effect and safety of one-staged hybrid surgery in the treatment of complicated Stanford B aortic dissection.Methods:246 consecutive patients who underwent one-staged hybrid technique with complicated type B aortic dissection (cTBAD) between January 2014 and July 2020 were retrospectively reviewed. The perioperative mortality and morbidity of the hybrid technique was assessed and the early results of follow up were evaluated.Results:The mean age of patients was(57.1±11.2)years old, and 175 (71.1%) were male. There were 166 cases of left common carotid artery-left subclavian artery vessels bypass + TEVAR (A group), operation time(62±8)min, post-operated hospitalization(5.2±1.3)days; 62 cases of right common carotid artery-left common carotid artery vessels bypass+ left common carotid artery-left subclavian artery vessels bypass + TEVAR (B group), operation time(88±12)min, post-operated hospitalization(6.1±1.8)days; 18 cases of debranch + TEVAR, operation time(236±36)min, post-operated hospitalization(8.8±2.1)days. 246 patients underwent hybrid procedure successfully (The technique success rate was 100%). 1 patient(0.4%)with traumatic aortic dissection (with cerebral trauma) died after operation 7 days. The average follow-up period was 5 years(30.3±7.1)xmonths. 236 patients(96%) without endoleak, 10 patients(4%)with proximal endoleak, 5 patients with regular follow-up, 5 patients with surgical treatment during one year (3 patients with re-TEVAR; 2 patients with opening operation); 25 patients(10.2%)incision hematomas, all these patients settled with closely observing and conservative treatment, and all these patients without reintervention. The rate of second intervention was 2% (5/246) the patency of bridging vessel was 99.7% (343/344). There was no paraplegia and stroke during perioperative period.Conclusion:One-staged hybrid surgery has a good short-term and med-term efficacy and safety for complicated Stanford B aortic dissection.
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Objective:To explore the value of fusion imaging in the treatment of complex aortic pathology.Methods:A retrospective analysis was conducted of 29 patients with complex aortic pathology who underwent treatment with endovascular aortic repair using fusion imaging (FI+ ) technique or without FI (FI-) between June 2015 and June 2021. The perioperative outcomes and morbidity of the FI was assessed and the early results of follow up were evaluated.Results:The mean age of patients was (70.3±7.3) years old, and 24 (82.8%) males. Technical success was 96.5% (28/29). The FI+ group patients had lower procedure time[FI+ , (209±53) min vs. FI-, (306±24)min, P=0.005]and ionic contrast medium[(169±23)ml vs. (201±20)ml, P=0.040]. Contrast-induced acute kidney injury (CI-AKI)[3.4%(FI+ 0 vs. FI-6.7%, P=0.33)], and operation-related reintervention[6.9%(FI+ 0 vs. FI-13.3%, P=0.16)] were similar. There were no significant differences in blood loss, fluoroscopy time. Conclusion:FI technique improves the accuracy during positioning in complex endovascular aortic repair, could reduce aortic related reintervention rate, operation time and contrast dose. Further studies and development are needed to obtain optimal image quality and higher precision.
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Objective:To evaluate the safety and clinical efficacy of AngioJet pharmacomechanical thrombectomy (APMT) in rescue treatment for patients with acute massive pulmonary embolism (AMPE) after unsuccessful thrombolysis with urokinase (UK).Methods:From June 2016 to June 2018, the clinical data of 16 AMPE patients underwent APMT after unsuccessful thrombolysis with UK were collected. For these patients, the therapy was discontinued and replaced with APMT adjunctive low-dose thrombolysis with UK. Heart rate (HR), systolic blood pressure (SBP), arterial partial pressure of oxygen (PaO 2), pulmonary artery pressure (PAP), CT obstruction index (CTOI) and therapy replacement safety were evaluated. The pared-samples t-test was used to analyze quantitative data before and after treatment. Results:All 16 patients completed APMT procedure. PAP posterior was lower than prior treatment ( P<0.05). The average adjunctive thrombolysis duration of UK was (3.25±1.78) d, HR, SPB, PaO 2 after APMT were significantly improved ( P<0.01). CTOI before and after APMT were (26.81±14.86)% and (11.56±3.26)%, respectively, and the difference was statistically significant ( t=3.435, P<0.01). Symptoms and signs of pulmonary embolism were significantly improved after treatment. The complications associated with APMT occurred in 2 patients with bradyarrhythmia, 2 patients with chest discomfort and 2 patients with hemoglobinuria. There were no statistically significant difference between the biochemistry indexes before and after APMT treatment ( P>0.05). Moreover, no major bleeding occurred during thrombolysis procedure, and minor bleeding complications occurred only in two cases. Conclusions:APMT adjunctive low-dose UK thrombolysis for rescue treatment of AMPE patients after unsuccessful thrombolysis with UK is relatively safe and effective. It can remove pulmonary artery thrombus rapidly, and improve clinical symptoms and signs of PE.
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Objective@#To investigate the safety and clinical efficacy of comprehensive endovascular treatment for acute deep vein thrombosis(DVT)in elderly patients.@*Methods@#Clinical data of 94 elderly patients who underwent endovascular treatment from June 2013 to June 2016 were retrospectively analyzed.All patients underwent inferior vena cava filter implantation(IVCF). Of them, 57 patients initially underwent thrombectomy and subsequently received the adjunctive catheter-directed thrombolysis(CDT)(Group A)and 37 cases underwent CDT(Group B). Clinical efficacy and safety of treatments in the two groups were examined.@*Results@#Among the 94 patients, 88 cases had retrievable IVCF, and the retrieval rate was 94.3%(83/88). There were significant differences in total infusion time(73.92±31.68 h vs.156.2±30.2 h)and total doses of infused thrombolytic agents(180.71±44.83 million unit vs.355.0±96.0 million unit)between Groups A and B(P<0.05). There was a significant difference in average hospitalized time between Groups A and B(9.4±2.4 d vs.12.8±4.3 d, t=-4.99, P<0.01). There was no significant difference in clinical efficacy between Groups A and B(χ2=1.263, P>0.05). Fifty-six patients were treated with angioplasty(PTA), 34 of them were combined with stent implantation, and there was no difference between the two groups(χ2=1.128, P>0.05). Neither of the two groups saw serious complications.The incidence of minor hemorrhage was 9.6%(9/94), including 2 cases and 7 cases in Group A and Group B respectively, and the difference was statistically significant(χ2=4.503, P=0.034). The average follow-up time was 16.7±8.3 months in the 94 patients, and the stent patency rate was 91.2%(31/34). Doppler ultrasonography results at the last follow-up showed that the reverse flow rate of the valve was 20.2%(19/94), the occurrence rates of post-thrombotic syndrome(PTS)were 24.6%(14/57)and 29.7%(11/37)in Group A and Group B respectively, and the difference was not statistically significant(χ2=0.307, P=0.580). Patients in the mild, moderate and severe stages assessed by Villata scoring were 9 vs.6, 4 vs.5, 0 vs.1 in Group A and Group B respectively, and the differences were not statistically significant(χ2=0.007 and 0.205, P>0.05).@*Conclusions@#It is safe and effective for elderly patients with DVT when timely and appropriate the treatment strategies are chosen and comprehensive approaches including IVCF, anticoagulation, endovascular CDT, thrombectomy, PTA and stent implantation are used.
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Objective To investigate the safety and clinical efficacy of comprehensive endovascular treatment for acute deep vein thrombosis(DVT)in elderly patients.Methods Clinical data of 94 elderly patients who underwent endovascular treatment from June 2013 to June 2016 were retrospectively analyzed.All patients underwent inferior vena cava filter implantation (IVCF).Of them,57 patients initially underwent thrombectomy and subsequently received the adjunctive catheterdirected thrombolysis(CDT)(Group A)and 37 cases underwent CDT(Group B).Clinical efficacy and safety of treatments in the two groups were examined.Results Among the 94 patients,88 cases had retrievable IVCF,and the retrieval rate was 94.3％ (83/88).There were significant differences in total infusion time(73.92 ± 31.68 h vs.156.2 ± 30.2 h) and total doses of infused thrombolytic agents (180.71± 44.83 million unit vs.355.0±96.0 million unit)between Groups A and B(P ＜0.05).There was a significant difference in average hospitalized time between Groups A and B(9.4±2.4 d vs.12.8 ± 4.3 d,t =-4.99,P ＜0.01).There was no significant difference in clinical efficacy between Groups A and B(x2 =1.263,P ＞ 0.05).Fifty-six patients were treated with angioplasty(PTA),34 of them were combined with stent implantation,and there was no difference between the two groups(x2=1.128,P ＞0.05).Neither of the two groups saw serious complications.The incidence of minor hemorrhage was 9.6％ (9/94),including 2 cases and 7 cases in Group A and Group B respectively,and the difference was statistically significant (x2 =4.503,P =0.034).The average follow-up time was 16.7± 8.3 months in the 94 patients,and the stent patency rate was 91.2％ (31/34).Doppler ultrasonography results at the last follow-up showed that the reverse flow rate of the valve was 20.2％ (19/94),the occurrence rates of post-thrombotic syndrome(PTS)were 24.6％ (14/57)and 29.7％(11/37) in Group A and Group B respectively,and the difference was not statistically significant(x2=0.307,P =0.580).Patients in the mild,moderate and severe stages assessed by Villata scoring were 9 vs.6,4 vs.5,0 vs.1 in Group A and Group B respectively,and the differences were not statistically significant(x2 =0.007 and 0.205,P＞0.05).Conclusions It is safe and effective for elderly patients with DVT when timely and appropriate the treatment strategies are chosen and comprehensive approaches including IVCF,anticoagulation,endovascular CDT,thrombectomy,PTA and stent implantation are used.
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Objective@#To investigate the safety and effectiveness of the Celect inferior vena cava filter (IVCF) in the treatment of deep venous thrombosis (DVT).@*Methods@#CT follow-up examinations were performed in 72 patients who underwent Celect inferior vena cava filter placement between August 2015 and September 2017. Forty-five patients (62.5%) presented with DVT alone, 27(37.5%) with DVT and pulmonary embolism (PE). With filters in place, each patient was followed up with CT at least once, to visualize new pulmonary embolism, inferior vena cava occlusion, filter tilting, fracture of struts, migration and penetration of struts through the inferior vena cava. Caval penetration was graded on a five-point scale.@*Results@#All Celect filters were successfully deployed. The interval between the filter placement and the CT was 5.0 to 695.0 days, mean (42.4±84.6)days. No new pulmonary embolism, cava occlusion, filter fracture and migration were found. Forty-two (58.3%) filters tilted, including tilt>15 degrees in 8 (11.1%) and tilt ≤15 degrees in 34 (47.2%). Caval penetration with 0 grade was observed in 47 (65.3%) and beyond grade 1 was observed in 25 (34.7%), including grade Ⅰ in 12 (16.7%), grade Ⅱ in eight (11.1%), grade Ⅲ in four (5.6%) and grade Ⅳ in one (1.4%). No patient presented with symptoms associated with caval penetration. Filter retrieval was attempted in 54(75.0%) patients,the indwell time was 5.0 to 111.0 days, mean(32.0±23.9) days. There were 52 (96.3%) filters successfully removed, including four filters tilted lead retrieval hook embedded the caval wall, which used the adjunctive retrieval techniques. Filter retrieval failure in two (3.7%) cases, including one case retrieval hook embedded the caval wall and the other with retrieval hook penetration.@*Conclusions@#Celect inferior vena cava filter can effectively prevent PE, but had a tendency to tilt and to penetrate caval wall, which affected the filter retrieval, and had the potential risk of serious complications such as abdominal aortic pseudoaneurysm. The filter should be removed as soon as the risk of PE is manageable. We advocate CT follow-up for patients with long-term inferior vena cava filter placement.
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Objective To assess the safety and efficacy of catheter-directed thrombolysis combined with percutaneous transluminal angioplasty (PTA) in treating acute thrombo-embolism of artificial arteriovenous fistula.Methods The clinical data of 64 patients with acute thrombo-embolism of artificial arteriovenous fistula (84 events in total),who were admitted to single medical center during the period from January 2012 to September 2016,were retrospectively analyzed.The diagnosis of acute thrombo-embolism of artificial arteriovenous fistula was confirmed by angiography via femoral approach in all patients.Mechanical thrombectomy of the thrombotic occlusion segment by using common guide wire was carried out first,which was followed by bolus injection of urokinase (125,000-375,000 units);if the thrombus was not completely dissolved the catheter would be retained and the urokinase would be continuously infused with a micro-pump until the thrombus was completely dissolved.Conventional balloon dilatation would be employed when the stenosis of artificial arteriovenous fistula lumen was ＞50％ or the stenosis impeded the performance of dialysis.Kaplan-Meier survival curve was used to estimate the primary and secondary cumulative patency rates after the first intervention.Results Of the 84 interventional procedures,technical success was achieved in 69 procedures (82.1％).A total of 14 conventional balloon dilatation procedures had to be conducted as the fistula was seriously narrowed,and up to 12 procedures (85.7％) were succeeded.The overall clinical success rate was 78.5％ (66/84).During the therapeutic course,bleeding event occurred in 7 procedures (8.3％),including major bleeding (n=3) and minor bleeding (n=4).After the treatment,the 3-,6-,12-,24-month primary and secondary patency rates were 76.1％,63.6％,40.8％,12.5％ and 81.3％,70.8％,47.0％,32.5％respectively.Conclusion For the treatment of acute thrombo-embolism of artificial arteriovenous fistula,catheter-directed thrombolysis is safe and effective,it can assist conventional balloon dilatation therapy to obtain satisfactory therapeutic result for internal fistula stenosis.
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Objective To compare the safety and clinical efficacy of recombinant human tissue plasminogen activator (rt-PA) and urokinase(UK)in catheter-directed thrombolysis(CDT)for the treatment of subacute iliofemoral deep venous thrombosis(DVT). Methods From June 2013 to June 2017, a total of 116 subacute DVT patients underwent consistent CDT with either rt-PA or urokinase, or simple anticoagulation treatment in this study.The patients were divided into three groups for comparison:rt-PA-CDT group(n=43), UK-CDT group(n=39)and anticoagulation group(n=34). The baseline data, thrombolysis duration, rt-PA or UK dosages, thrombolytic rate and clinical efficacy rate were compared among the three groups. Independent t-test(accorded to normal distribution)was used to analyze the thrombolysis duration.The quantitative data were analyzed with analysis of varianc and the qualitative data were compared by the chi-square test. Results There was no significant difference in general clinical features among the three groups(P>0.05). The thrombolysis duration, total dosages and thrombolytic rate (≥50)were(5.8±1.3)d,(49.7±16.1)mg,86.0% for rt-PA-CDT group,and(6.3±1.5)d,(440±99)×104 U, 66.7% for UK-CDT group.The difference of thrombolysis duration was not statistically significant between the rt-PA-CDT group and UK-CDT group(t=-1.868, P>0.05). The thrombolysis rate of rt-PA-CDT group was significantly higher than that of UK-CDT group(χ2=4.315, P<0.05). The time of obtaining grade Ⅲthrombosis rate was shorter for rt-PA-CDT group(4.7±0.9)d compared with UK-CDT group(6.0±1.2 d) (t=-2.343,P<0.05).The clinical efficacy rates of the rt-PA-CDT group[88.4%(38/43)]and UK-CDT group [76.9%(30/39)]were significantly higher than that of anticoagulation group[26.5%(9/34)](P<0.05).There was no statistical difference between the rt-PA-CDT group and UK-CDT group(χ2=1.893, P>0.05). No severe complications were found in all groups. The incidence rates of mild complication of the rt-PA-CDT group, UK-CDT group and anticoagulation group were 16.3%(7/43), 17.9%(7/39)and 8.8%(3/34), respectively, and there were no significant differences among the three groups(χ2=1.396, P>0.05). Conclusion The clinical efficacy of CDT using rt-PA and UK for subacute DVT is better than simple anticoagulation treatment.Thrombolytic rate of rt-PA is superior to UK.
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Objective To compare the clinical efficacy of angioJet rheolytic thrombectomy (ART) and manual aspiration thrombectomy (MAT) combined with catheter-directed thrombolysis (CDT) in the treatment of acute iliofemoral venous thrombosis (IFVT).Methods 62 acute IFVT patients undergoing interventional treatment with either ART (group A,30 cases) or MAT (group B,32 cases) from 2014 to 2016,were enrolled in this study.Clinical efficacy and postthrombotic syndrome (PTS) rate were compared between the two groups.Results The instant thrombolysis rate in group A was 83.3％ (25/30),that was 59.4％ (19/32) in group B(P ＜ 0.05).Time used for adjunctive thrombolysis and dosages of UK in group A were (73.92 ±31.68)h and (110.71 ±44.83) × 104 U,while in Group B were (121.20 ±25.20)h and (313.49 ± 70.11) × 104 U,respectively (P ＜0.01).Final thrombolysis rate of these two groups were 93.3％ (28/30) and 87.5％ (28/32) (P ＞ 0.05).No severe complications occurred during the treatment of ART and MAT procedure.Fifty seven cases (91.9％) were followed-up,the valvular regurgitation rate in group A and group B were 14.3％ (4/28) and 37.9％ (11/29),respectively (P ＜ 0.05).PTS rate in group A was 25.0％ (7/28) and 37.9％ (11/29) in group B (P ＞0.05).Conclusions Interventional treatment for acute IFVT with ART and MAT can both achieve high clinical efficacy.ART are with higher instant thrombolysis rate and less valvular regurgitation compared with MAT.
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Objective To evaluate the clinical value of percutaneous AngioJet thrombectomy for acute iliofemoral deep venous thrombosis.Methods 50 patients were divided into AngioJet thrombectomy group(25 cases) compared with bolus injection of urokinase through catheter in control group (25 cases).When the thrombosis was completely dissolved,the PTA and stents were implanted in those patients presenting May-Thurner syndrome in both groups.Inferior vena cava filter was retrieved from the patients and the thrombolytic therapy was discontinued.The patency rate of iliofemoral venous was assessed by CTA at 1 and 6 months after the procedure.Results The average dosage of urokinase in AngioJet patients was (880 000 ± 354 000) units.The mean duration time of catheter-directed thrombolysis was (42.2 ± 16.7) hours and the average hospitalization time is (3.8 ± 0.8) days.Grade Ⅲ thrombolysis was achieved in 18 limbs and grade Ⅱ lysis in 6 limbs,grade Ⅰ lysis in 1 limb.The mean duration time of catheter-directed thrombolysis was (129.6 ± 32.2) hours.The average dose of urokinase was (4 100 000 ± 1 060 000) units and the average hospitalization time was (7.9 ± 1.4) days in control group.Grade Ⅲ thrombolysis was achieved in 10 limbs,grade Ⅱ lysis in 9 limbs and grade Ⅰ lysis in 6 limbs.The dosage of urokinase,duration time of catheter-directed thrombolysis,time in hospital and clinical effects were statistically different between the two groups (all P ＜ 0.05).There were no recurrent thrombosis in all the patients after 6 months of treatment.Venous patency was maintained in all patients with implanted stent.Conclusions Percutaneous AngioJet thrombectomy with adjunctive thrombolytic therapy is an effective,safe treatment modality in patients with acute iliofemoral vein thrombosis.
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Objective To discuss the clinical application of mechanical thrombectomy with AngioJet system for acute lower limb arterial ischemia (ALI).Methods A total of 12 ALI patients,who underwent percutaneous mechanical thrombectomy with AngioJet systemn during the period from January 2015 to November 2016,were enrolled in this study.The clinical data were retrospectively analyzed.The blood flow classification score after thrombolysis in myocardial infarction (TIMI) was used to evaluate the blood perfusion condition,and Cooley standard of efficacy score was used to assess the clinical curative effect.Results The technical success rate of mechanical thrombectomy with AngioJet system was 91.7％ (11/12).The average restored perfusion time was (1.5±0.6) hours.The clinical success rate and limb salvage rate were 83.3％ (10/ 12) and 91.7％ (11/12),respectively.The TIMI flow scores were improved from preoperative grade 0 (n=8) and Ⅰ (n=4) to postoperative grade 0 (n=1),Ⅰ (n=3) and Ⅱ (n=8).In 11 patients (91.7％) the symptoms of lower limb arterial ischemia were strikingly improved after mechanical thrombectomy.In one patient,the postoperative TIMI flow score remained 0 as preoperative state and the symptoms of lower limb arterial ischemia were not improved although catheter directed thrombolysis therapy was employed for 24 hours,and above-knee surgical amputation had to be carried out.Cooley efficacy score showed that complete cure was seen in 4 patients (33.3％),good response in 6 patients (50.0％),general improvement in one patient (8.3％) and pool response in one patient (8.3％).No severe bleeding complications occurred.Conclusion Percutaneous mechanical thrombectomy with AngioJet can rapidly recover the blood perfusion in patients with ALI,thus,further deterioration of the disease can be prevented and the limb salvage rate can be improved.Therefore,this technique has good clinical application value.
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Objective To evaluate multi-slice spiral CT venography (MSCTV) and digital subtraction venography (DSV) in diagnosing iliac vein compression syndrome (IVCS) and secondary thrombosis. Methods The imaging materials, including MSCTV and DSV performed before and after the thrombolysis therapy, of 38 patients with clinically-suspected IVCS were collected. The inner diameters of the compressed iliac veins were measured on MSCTV images and the compression ratio was calculated. Usingχ2 test, the detection rates of IVCS by MSCTV and DSV were compared. Results Of 38 patients, IVCS was detected by MSCTV in 29, by pretreatment DSV in 20 and by post-treatment DSV in 29. The difference in the detection rate of IVCS between MSCTV and pre-treatment DSV was statistically significant (χ2=4.65, 0.010.05). Conclusion For the diagnosis of IVCS, MSCTV is superior to pre-treatment DSV in the diagnostic accuracy of iliac vein compression syndrome. Therefore, MSCTV should be used as the preferred method of examination.(J Intervent Radiol, 2015, 24:301-305)
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Objective To explore the clinical features, diagnosis and interventional management of acute deep venous thrombosis of lower extremity (LEDVT)combined with type Ⅱ heparin-induced thrombocytopenia (HITⅡ) and to improve the knowledge of this disease. Methods A retrospective review and analysis of the clinical data of the patients with acute LEDVT combined with HIT Ⅱ enrolled from January 2010 to June 2014. All of them underwent anticoagulation with low molecular weight heparin (LMWH) and the comprehensive interventional therapy at the beginning of treatment.When HIT Ⅱ was identified, all forms of heparin and LMWH were avoided . Alternative anticoagulation was commenced with argatrobam. Adjustments in interventional therapy were taken while the short-term low-dose glucocorticoid treatment were used.The clinical manifestations, changes of PLT, 4Ts score (Warkentin 4T scoring system, 4Ts) , HIT antibody assay (ELISA) and response to therapy of the patients were analyzed and the treatment effect was observed . The efficacy of interventional therapy was evaluated according to the improvement clinical symptoms and venography. Results The incidence of acute LEDVT combined with HIT Ⅱ was 1.9%(8/416). There were 4 males and 4 females with a median age of 24 years in this study. The median time between their initiation exposure to heparin and onset of thrombocytopenia was 5 days (range,3 to 8 days). The median platelet counts prior to HIT Ⅱ was 218 × 109/L( range,122 × 109/L to 254 × 109/L ). Platelet counts decreased to the lowest level range from 20 × 109/L to 51 × 109/L(median 32 × 109/L). After alternative anticoagulation, the interval period which PLT recovered to the basic level was range from 3 to 7 days (median 3.5 days) . According to the score of 4Ts , there were 2 cases score 6 and 6 cases score 8. HIT antibody assay (ELISA) was detected in 6 patients which the results were positive. During heparin anticoagulation treatment, the LEDVT condition of all patients continued to deteriorate. Vein thrombosis extended in 7 patients. Among them, 5 patients occurred new thrombosis in the inferior vena cava and(or) at the vessel of catheter insertion. Another 2 patients complicated with pulmonary embolism. After underwent anticoagulation with argatrobam , with the increased of PLT the treatment efficacy of thrombolysis therapy was ameliorated. At the endpoint of interventional therapy, the curative effect evaluation was excellent in 3 cases, good in 3 cases and medium in 2 cases respectively. All patients were followed up for 12 to 20 months (median 15.5 months) with no evidence of recurrence .Conclusions The study showed that acute LEDVT combined with HITⅡdisplayed the following features:(1)an absolute drop in platelet count below the normal range (PLT ≤100 × 109/L) or as a relative decrease of 30% to 50% from baseline counts. (2) refractory venous thrombosis,during the interventional treatment of acute LEDVT, platelets counts should be monitored regularly in patients who receiving heparin anticoagulation. For patients with strongly suspected HIT Ⅱ, withdrawal of all forms of heparin and early introduction of alternative anticoagulant therapy can improve the effect of interventional therapy.
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Objective To investigate the effect of endovascular treatment to initial and long-term outcomes of postpartum deep venous thrombosis (DVT) . Methods The clinical data, venography and 3-yaer follow up data of 30 female patients with acute or subacute deep vein thrombosis in the postpartum period who received endovascular therapy consisting of catheter-directed thrombolysis with angioplasty (stenting for some patients with iliac vein compression syndrome (IVCS)) were retrospectively evaluated. Clot removal was graded as grade Ⅲ(>95%), grade Ⅱ(50% to 95%), and grade Ⅰ(0.05).For 18 patients with IVCS, there was significant statistical difference between patients implanting stents(initial patency was 100.0%(7/7) and whom not implanting stents(initial patency was 63.6%,7/11) (χ2=5.14, P0.05). Conclusions Endovascular therapy consisting of catheter-directed thrombolysis with angioplasty could be considered as a primary therapeutic procedure in patients with acute or subacute postpartum DVT. Stenting for treatment of iliac compression which contributed to postpartum DVT is very valuable to ensuring higher long-term patency rate.
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Along with increasing use of inferior vena cava (IVC) filter implantation, more and more attention has been paid to the filter - related complications by scholars both at home and abroad. For the present the generally accepted filter- related complications include filter deformation, filter tilt, filter fracture, filter migration, IVC perforation, IVC thrombosis, IVC occlusion, recurrence of pulmonary embolism, deep vein thrombosis (DVT), post - thrombosis syndrome (PTS), etc. Accurate recognition of filter - related complications and prompt use of appropriate measures that are directed against a given complication in order to reduce or avoid complications are of great clinical significance in applying the inferior vena cava filter to clinical practice in a more safe and effective way. This paper aims to make a comprehensive review about the filter- related complications and the research progress concerning their prevention in recent years.
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<p><b>OBJECTIVE</b>To assess the clinical efficacy of retrograde puncture subintimal angioplasty (SIA) for treatment of occlusive diseases in the long segment of the infrapopliteal artery.</p><p><b>METHODS</b>The clinical data of 50 patients with occlusive diseases in the long segment of the infrapopliteal artery were retrospectively analyzed. The patients were divided into control group (n=25) and study group (n=25) and received antegrade SIA and retrograde puncture SIA with long balloon after the failed antegrade SIA, respectively. The ankle brachial index (ABI) and the temperature of the infrapopliteal skin before and after the operation were compared between the two groups.</p><p><b>RESULTS</b>The technical success rate was 100% in the 50 patients, who showed obviously improved ischemic symptoms without serious complications. The ABI of the study group increased from 0.31 ± 0.12 before the treatment to 0.47 ± 0.09 at 24 h, 0.56 ± 0.06 at 1 week, 0.63 ± 0.07 at 3 months, 0.58 ± 0.06 at 6 months, and 0.49 ± 0.03 at 12 months after the treatment, and the skin temperature increased from 28.13 ± 2.45 before the operation to 33.87 ± 1.24, 34.16 ± 0.44, 34.19 ± 0.25, 32.45 ± 0.25, and 31.05 ± 0.21 at the corresponding time points after the treatment, respectively, showing significant improvements after the operation (P<0.05). ABI, skin temperature and the patency rate were similar between the two groups at each of the postoperative time points (P>0.05).</p><p><b>CONCLUSION</b>Retrograde puncture SIA is safe and effective for treatment of arteriosclerosis obliterans in the infrapopliteal arteries with a high clinical success rate and a low complication rate after the failure of antegrade SIA.</p>
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Humans , Angioplasty , Ankle Brachial Index , Arterial Occlusive Diseases , General Surgery , Femoral Artery , Pathology , Popliteal Artery , Pathology , Retrospective StudiesABSTRACT
Objective To investigate the safety and clinical efficacy of catheter-directed thrombolysis(CDT) with prolonged infusion of low dose urokinasefor treatment of acute iliac-femoral vein thrombosis.Methods From January 2005 to March 2011,63 patients of unilateral acute iliac-femoral vein thrombosis were treated by CDT and followed up for more than 12 months.The complications during CDT,thrombus clearance ratio,time for CDT,dose of urokinase,degree of limb swelling and clinical follow-up data were retrospectively reviewed.The Fisher exact test was used for enumeration of data.The measurements of data were tested with the one-way analysis of variance and two-two comparison LSD test.Thrombus clearance ratio in different time frame was tested by repeated measurement of data and analysis of variance.Results During the CDT,no symptomatic pulmonary embolism (PE) and significant bleeding happened.Ten (15.9％) patients had complications of minor bleeding,including 3 patients with blood oozing along the edge of vascular sheath,3 patients with subcutaneous ecchymosis or hematoma around the puncture site,3 patients with hematuria and 1 patient with gums bleeding.In four (6.3％) patients,complications were caused by catheter placement,including 3 patients with soft tissue inflammation around puncture site and 1 patient with secondary thrombosis surrounding the vascular sheath.Fifty three patients (84.1％) achieved thrombolytic degree Ⅲ and Ⅱ at 4th to 8th day during CDT.Thrombus clearance ratio was higher in CDT with urokinase 500 000 U/d and 750 000 U/d than 250 000 U/d[(91.2 ± 10.1)％ vs (75.9±20.1)％,(91.3 ± 12.2)％ vs (75.9±20.1)％,all P ＜0.05].Thrombus clearance ratio showed no significant difference between CDT with urokinase 500 000 U/d and 750 000 U/d [(91.2 ±10.1) ％ vs (91.3 ± 12.2) ％,P ＞0.05].There was no significant difference between CDT with urokinase 500 000 U/d and 750 000 U/d in perfusion thrombolytic time to reach thrombolytic degree Ⅲ [(7.1 ± 1.0)vs (6.2±1.3)d,P＞0.05]and Ⅱ[(6.4±1.0) vs (6.0±0.8)d,P＞0.05].Thrombus clearance ratio increased along with an increase in thrombolytic time for CDT (P ＜ 0.05).After 24 hours of CDT,58 (92.1％) patients showed reduction of soft tissues tension.After 48 hours of CDT,affected limb circumference decreased significantly compared with the preoperative measurement [thigh (54.25 ±5.79) cm vs (56.46±5.91) cm; leg(44.05 ±5.18) cm vs (45.68 ±5.16) cm,all P＜0.05].At the time of discharge,there was no significant difference between affected limb circumference and normal side [thigh (49.00±4.67) cmvs (48.38 ±4.68) cm; leg(38.41 ±4.15) cm vs (37.73 ±3.92)cm,all P ＜ 0.05].The patency rate of iliac venous stent was 91.1％ (41/45) after 6 months.Doppler ultrasound showed regurgitation of femoral venous valve in 11 patients after 12 months.Conclusions CDT with prolonged infusion of low dose urokinase is a safe,highly effective method for the treatment of acute iliacfemoral venous thrombosis.
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Objective To assesse prognostic factors regarding long-term primary patency for patients who underwent intra-arterial thrombolysis and/or adjuvant endovascular techniques due to acute lower limb ischemia. Methods Consecutive patients with ALI of the lower extremities treated via interventional methods between January 2005 and June 2010 were identified and reviewed ( exclude patient suffered from aortic dissection involved artery of lower extremity or trauma). Analyze the potential variables with univariable analysis and only factors associated with long-term primary patency with a P value less than 0.1 in univariable analysis were introduced into the Cox regression mode.Total long-term primary patency and grouped primary patency were assessed using Kaplan-Meier estimation.Results The analyzed dataset included 107 limbs treated in 101 patients presenting with ALI (class Ⅰ 15,class Ⅱ A 36,class Ⅱ B to Ⅲ 56,according to Rutherford classification ).Eight nine limbs were enrolled in follow-up.The mean followup was 34 months ( range:1 to 53 months).Primary patency at 12,24 and 36 months was 87％,68％ and 55％,respectively.Multivariable analyses identified patients presenting with diabetes mellitus ( P =0.00),PAOD ( P ＜ 0.02 ) and thrombolysis time ( P ＜ 0.02 ) were associated with primary patency.Compare the patency rate of patients with different thrombolysis time,the results showed that the patency rate of the patients thrombolysis time less than 4 d was higher than those more than 4 c. Conclusions lnterventional therapy remains an effective treatment option for patients presenting with lower extremity ALI.Diabetes mellitus and PAOD negatively affect the rates of limb primary patency. Thrombolysis should be limited to ＜4 days.
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ObjectiveTo investigate the anatomical distribution of acute deep venous thrombosis (DVT) of the lower extremity,and compare different therapeutic methods including anticoagulation alone,thrombolysis through dorsal vein and interventional therapy.MethodsThe clinical data,venography and therapies of 204 acute DVT patients were retrospectively studied According to the distribution,DVT were classified into three types including peripheral,central and mixed types.According to the difference of the therapeutic method,each type of DVT was divided into three groups,Group A (37 patients) anticoagulation alone:Group B(55 patients) thrombolysis through dorsal vein:and Group C( 112 patients) interventional therapy.The results of different kind of treatment method in each type of DVT were evaluated before the patients were discharged and the Chi-square test was used for statistical analysis.Results There were 132 patients with DVT in the left lower extremity,62 in right lower extremity,and 10 in both extremities.The complication of pulmonary embolism (PE) occurred in 4,5 and 2 cases respectively,and the morbidity was 3.0％,8.1％ and 20.0％ ( x2 = 6.494,P = 0.039 ) respectively.There was significant statistical difference among them.There were 23 cases of peripheral type of DVT,48 central type and 133 mixed type.The complication of PE were observed in 2,5 and 4 cases respectively in each type.The morbidity was 8.7％,10.4％ and 3.0％ respectively ( x2 = 4.350,P = 0.114 ).There were no statistical significance among them.In the 23 cases of peripheral type DVTs,2 of 5 in group A and 11 of 18 in group B had excellent therapeutic response.In the 48 cases of central type of DVTs,1 of 10 in group A,2 of 5 in in group B and 26 of 33 in group C had excellent therapeutic response.There were statistically significant differences among groups A,B and C ( x2 = 16.157,P =0.000).In the 133 cases of mixed type DVTs,1 of 22 in group A,10 of 32 in group B and 65 of 79 in group C had excellent therapeutic response.There were statistically significant differences among group A,B and C ( 1,10,65 cases,x2 = 53.993,P =0.000).ConclusionsThe incidence of acute DVT involving the left lower extremity was higher than that involving the right one,and the majority of cases was of the mixed type.The treatment of choice for the central and mixed types was interventional therapy.Analysis of anatomical distribution of deep venous thrombosis can guide treatment planning.
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ObjectiveTo investigate prospectively the feasibility and clinical value of catheterization via the ipsilateral great saphenous vein in catheter-directed thrombolysis (CDT) for acute iliofemoral deep vein thrombosis (IFVT) by a comparative study.MethodsThe prospective study included 93 cases of IFVT proved by venography.All patients were divided into three groups randomly.In group A,31 patients received CDT via the ipsilateral great saphenous vein.In group B,27 patients received CDT via the ipsilateral popliteal vein.In group C,35 patients received anterograde thrombolysis via an ipsilateral dorsalis pedis vein.Urokinase was adopted as the thrombolytic agent in all cases.The assessment of the curative effect include therapeutic effective rate,rate of edema reduction and venous patency which were observed according to the clinical symptoms and the follow-up venograms obtained 5 days after thrombolysis.The time and comfort scores of procedures was recorded and compared between group A and B using two independent samples t test.The rate of edema reduction and venous patency were assessed using analysis of variance (LSD method).Therapeutic effective rate and complication rate were assessed using Chi-square test.Results The total effective rate of the three groups were 90.3％ (28/31),92.6％ (25/27) and 68.6％ (24/35) respectively.The limbs edema reduction rate were (83.5 ±21.1)％,(82.4 ±20.1)％,and(67.0±23.3)％ respectively(F=6.059,P = 0.003 ).The venous patency rate after thrombolysis were (61.2 ± 20.2) ％,(55.7 ± 20.5 ) ％,and (44.2 ±23.6)％ respectively.There was no significant difference between group A and B in therapeutic effective rate( x2 =0.09,P =0.759),rate of edema reduction( P =0.822 ) and venous patency ( P =0.343 ).There was a significant difference statistically in therapeutic effective rate(x2 =4.65,P =0.031 ),rate of edema reduction (P = 0.002) and venous patency (P = 0.002) between group A and C.Compared with group A and B,the procedure time [group A (8.3 ±3.1) min,group B (16.3 ±3.5) min,t =9.379,P ＜0.05],comfort scores during treatment [ group A (2.2 ± 1.2),group B (5.0 ± 1.4 ),t = 8.129,P ＜ 0.05 ] had statistical significant difference.The CDT-asscciated complications in group A were less than group B significantly(3 cases in group A,11 cases in group B,x2 =7.60 P ＜0.05).ConclusionsCatheterizationvia the great saphenous vein in CDT therapy for acute IFVT is feasible and effective.It is easily operable with less complications.