Clinical Comparison of the Efficacy of Systemic Thrombolysis,Catheter-Directed Thrombolysis,and AngioJet Percutaneous Mechanical Thrombectomy in Acute Lower Extremity Deep Venous Thrombosis / 中国医学科学院学报

Objective To compare the clinical effects of three treatment methods including systemic thrombolysis(ST),catheter-directed thrombolysis(CDT),and AngioJet percutaneous mechanical thrombectomy(PMT)in acute lower extremity deep venous thrombosis(LEDVT). Methods The data of 82 patients diagnosed with LEDVT in the Department of Vascular and Gland Surgery of the First Affiliated Hospital of Hebei North University from January 2017 to December 2020 were collected.The patients were assigned into a ST group(n=50),a CDT group(n=16),and a PMT group(n=16)according to different treatment methods.The efficacy and safety were compared among the three groups. Results Compared with that before treatment,the circumferential diameter difference of both lower limbs on days 1,2,and 3 of treatment in the ST,CDT,and PMT groups reduced(all P<0.001).The PMT group showed smaller circumferential diameter difference of lower limbs on days 1,2,and 3 of treatment than the ST group(all P<0.001)and smaller circumferential diameter difference of the lower patellar margin on day 1 of treatment than the CDT group(P<0.001).The PMT group showed higher diminution rate for swelling of the affected limb at the upper and lower edges of the patella than the ST group(P<0.001)and higher diminution rate for swelling at the upper edge of the patella than the CDT group(P=0.026).The incidence of complications after treatment showed no significant differences among the three groups(all P>0.05).The median of hospital stay in the PMT group was shorter than that in the ST and CDT groups(P=0.002,P=0.001).The PMT group had higher thrombus clearance rate than the ST group(P=0.002)and no significant difference in the thrombus clearance rate from the CDT group(P=0.361).The vascular recanalization rates in the PMT(all P<0.001)and CDT(P<0.001,P=0.002,P=0.009)groups 3,6,and 12 months after treatment were higher than those in ST group,and there were no significant differences between PMT and CDT groups(P=0.341,P=0.210,P=0.341). Conclusions ST,CDT,and PMT demonstrated significant efficacy in the treatment of LEDVT,and PMT was superior to ST and CDT in terms of circumferential diameter difference of the lower limbs,diminution rate for swelling of the affected limb,thrombus clearance rate,length of hospital stay,and long-term vascular recanalization.There was no obvious difference in safety among the three therapies.

Distal embolic filter protection during debulking treatment of peripheral artery disease / 中华普通外科杂志

Objective:To discuss the strategies of distal embolic filter protection(DEFP) during excimer laser ablation (ELA) or percutaneous mechanical thrombectomy (PMT) in treatment of peripheral artery disease.Methods:Clinical data of 29 patients undergoing ELA or PMT under the DEFP from Oct 2019 to Aug 2021 were retrospectively collected to analyze the strategies of DEFP and high-risk factors of capturing clinically significant macrodebris.Results:There were 21 males and 8 females, aged (70.3±11.0) years with 32 lesions (29 limbs) including 5 in-stent restenosis (ISR), 10 thrombosis and 17 chronic total occlusion (CTO). The technical success rate of DEFP device release and recovery was 100%. The overall debris capture rate was 77.3% and the macrodebris capture rate was 36.4%. Even with DEFP the distal embolization (DE) incidence was 3.4%. When ELA for CTO with severe calcification or long-segment ISR lesions, the capture rate of macrodebris was as high as 60.0%, and the former was significantly higher than ELA for CTO without high calcification lesions ( P<0.05). Conclusion:ELA or PMT under the DEFP in treatment of peripheral artery disease appears to be of great significance in preventing DE.

Clinical Analysis of the Treatment of Iliac Limb Occlusion Following Endovascular Abdominal Aortic Aneurysm Repair / 中国医学科学院学报

Objective To explore the cause and the treatment strategies of iliac limb occlusion after endovascular abdominal aortic aneurysm repair(EVAR). Methods The patients receiving EVAR in PUMC Hospital from January 2015 to December 2020 were retrospectively analyzed.Sixteen(2.7%)cases of iliac limb occlusion were identified,among which 6,9,and 1 cases underwent surgical bypass,endovascular or hybrid procedure,and conservative treatment,respectively. Results Fifteen cases were successfully treated.During the 10.6-month follow-up,2 cases receiving hybrid treatment underwent femoral-femoral bypass due to re-occlusion of the iliac limb. Conclusions Iliac limb occlusion mostly occurs in the acute phase after EVAR,and endovascular or hybrid treatment can be the first choice for iliac limb occlusion.It is suggested to focus on the risk factors for prevention.

Treatment strategy of peripheral arterial diseases with Rotarex / 中华普通外科杂志

Objective:To evaluate the effect of Rotarex in peripheral arterial disease (PAD).Methods:The clinical data of 90 PAD patients treated with Rotarex from Aug 2018 to Feb 2020 were retrospectively analyzed.Results:Among the 90 patients, 45 patients had atherosclerotic obliterans complicated with acute thrombosis (ASOCAT), 27 patients had graft restenosis or reocclusion, 16 patients had primary or embolism-induced thrombosis, 2 patients had traumatic or iatrogenic arterial occlusion. Except for 2 patients undergoing hybrid surgery, 88 patients underwent endovascular treatment. Two patients died perioperatively. Within 12 months follow-up, 2 patients died, 4 patients underwent major amputation, target arteries of 10 patients were re-stenosed or re-occluded and 5 patients were lost to follow-up. Compared with the preoperative ankle-branchial index (ABI), significant increase was observed in the 12-month ABI (0.80±0.22 vs. 0.43±0.16, P<0.01). The 12-month restenosis/re-occlusion-free rate was 82.7%, and the 12-month major amputation-free survival (MAFS) was 91.6%. Conclusion:For PAD patients, acceptable outcomes can be achieved with reasonable use of Rotarex for debulking, combined with balloon, stent and other techniques to correct the residual lesions.

Clinical study of AngioJet thrombectomy for rescue treatment of acute massive pulmonary embolism after unsuccessful thrombolysis: preliminary results / 中华放射学杂志

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.

Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis in the treatment of deep venous thrombosis of lower extremity via contralateral femoral vein approach / 上海交通大学学报（医学版）

Objective: To analyze the early clinical effects of acute deep venous thrombosis (DVT) of the lower extremities through a contralateral femoral vein approach by percutaneous mechanical thrombectomy (PMT) combined with catheter-directed thrombolysis (CDT) therapy. Methods: A retrospective analysis about 45 patients (from September 2016 to August 2017) was conducted to analyze the success rate of the technique, the degree of thrombolysis in different venous segments, and the incidence of complications during the treatment of PMT+CDT. Results: Technique successful rate was 100%. 86.7% of lower extremity thrombosis (LET) segments (calf veins), 82.2% of LET Ⅱ segments (femoral and popliteal veins) and 71.1% of LET III segments (common iliac and femoral veins) were completely dissolved. No serious complications occurred. Conclusion: It is feasible, safe and effective to use PMT+CDT in acute DVT.

Interventional treatment for acute iliofemoral venous thrombosis: a comparison between angioJet rheolytic thrombectomy and manual aspiration thrombectomy / 中华普通外科杂志

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.

Percutaneous AngioJet thrombectomy for acute iliofemoral deep venous thrombosis / 中华普通外科杂志

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.

The application of percutaneous mechanical thrombectomy with AngioJet system in management of acute lower limb arterial ischemia / 介入放射学杂志

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.

Percutaneous mechanical thrombectomy with subsequent iliac vein stent implantation accomplished by single-procedure for acute deep venous thrombosis of lower extremity: preliminary results in 12 cases / 介入放射学杂志

Objective To evaluate the feasibility,safety and effectiveness of percutaneous mechanical thrombectomy (PMT) and iliac vein stent implantation which are accomplished by single-procedure in treating acute deep venous thrombosis (DVT) of lower extremity.Methods During the period from December 2014 to January 2016,a total of 12 patients with acute DVT of lower extremity,including 3 males and 9 females with a mean age of (50.42±16.21) years old,were admitted to authors' hospital to receive treatment.Clinically,all patients presented with left leg swelling and pain.Central type of DVT was seen in 3 patients and mixed type of DVT was found in 9 patients.Preoperative placement of inferior vena cava filter was employed in all patients,which was retrieved after the treatment.PMT by using Angio Jet thrombus removal catheter,balloon angioplasty,and iliac vein stent implantation were successively carried out during the same procedure.When residual thrombus was identified on checkup angiography the catheter sheath would be reserved,and the thrombolytic therapy would be adopted.The patients were followed up at outpatient clinic at one,3,6 and 12 months after the treatment,and reexamination of color ultrasound and/or lower limb venography was used to assess the blood flow in the deep veins and in the stents.Results The combination of several therapies was accomplished in a single procedure,the technical success rate was 100％.The used time for the operation was 60-110 minutes,with a mean of (96.25±14.32) minutes.The used time for thrombus aspiration was 51-280 seconds,with a mean of (199.92±74.89) seconds.Thrombus clearance rate of grade Ⅲ was obtained in 10 patients,and thrombus clearance rate of grade Ⅱ was seen in 2 patients;the clinical symptoms were improved in all patients.Except some patients complained of different degrees of pain during the performance of balloon dilatation of left common iliac vein,no serious complications such as pulmonary embolism,severe hemorrhage,etc.occurred.The patients were followed up for (5.58±2.75) months;color ultrasound and/or lower limb venography performed in 11 patients showed that the blood flow in deep veins and iliac vein stents was unobstructed,and relapse of DVT was observed in one patient with cerebral astrocytoma.Conclusion For the treatment of DVT of lower extremity,PMT combined with iliac vein stent implantation that is accomplished by single-procedure is safe and feasible,its preliminary clinical results are satisfactory.

Treatment of superior mesenteric artery embolism by percutaneous mechanical thrombectomy with the SolitaireAB stent system / 实用放射学杂志

Objective To evaluate the curative effect and security of mechanical thrombectomy with SolitaireAB stent system in acute superior mesenteric artery embolism(SMAE).Methods The clinical data of 5 cases who had undergone mechanical thrombectomy with SolitaireAB stent system under digital subtraction angiography (DSA) were analyzed retrospectively.Results A successful thrombus removal of superior mesenteric arterial by SolitaireAB stent system was observed in the whole 5 patients.The patients had recovered well after operation and no complications such as arterial dissection,perforation and hemorrhage or intestinal ischemia occurred.Conclusion The arterial mechanical thrombectomy with SolitaireAB stent system are characterized with high rate of recanalization,fine security,minimal invasion and less complications in patients with acute superior mesenteric arterial embolism.

The clinical analysises of percutaneous mechanical thrombectomy apply to vascular disease / 国际外科学杂志

For recently 30 years,with the progress of science,the development of intracavitary technology has been constantly improved and expanded.Reascularization technology makes the cure of vaso-occlusive disease a great leap.Because of its small trauma,repeatable,high security,near future curative effect,interventional therapy is distinctly superior to the traditional treatment such.Peripheral vascular lumen treatments including the balloon dilatation,stent-assisted angioplasty,catheter guided thrombolysis,and percutaneous mechanical thrombectomy,etc.Although angioplasty has become the best choice but the preferred treatment has limitations,such as for long and severe calcification of arteries occlusion surgery is difficult,immediate and long-term patency rate is low,the postoperative complications is frequent;Used for plaque ulcer and potentially thromboembolic disease,body highly risks of distal embolization;Inherent retraction force for postoperative lumen,intimal inflammation restenosis,stent thrombosis cause problems frequently.However,the percutaneous mechanical thrombectomy system is aimed at solving the clinical problems with good combination of engineering and technology research.The purpose of this paper is to expound the existing mechanical embolus removal system:SilverHawk/TurbjHawk aod Straub Rotarex thrombus,that is to elaborate its development status and clinical analysis.

A Case of Mechanical Thrombolysis of Thrombosed Native Hemodialysis Fistula Using Arrow Trerotola Percutaneous Thrombolytic Device / 대한신장학회잡지

Adequate care of patients with end-stage renal failure on hemodialysis requires permanent vascular access. Arteriovenous fistula obstruction due to venous thrombosis is commonly observed complication, contributing significantly to morbidity and hospitalization of dialysis patients. Percutaneous intervention using angioplasty and thrombolysis has become an accepted treatment of thrombosed vascular access and demonstrates comparable technical results and patency rates with those of surgery. Recently developed percutaneous mechanical thrombectomy (PMT) uses mechanical energy to clear thrombus percutaneously in combination with mechanical dissolution, fragmentation, and aspiration. PMT offers fast thrombus removal without complications related to thrombolytic therapy. We report a case of thrombosed hemodialysis native fistula which was successfully treated with percutaneous angioplasty and mechanical thrombolysis using newly introduced Arrow-Trerotola percutaneous thrombolytic device.