Interventional mechanical thrombectomy treatment for chronic vascular thrombus / 介入放射学杂志

ABSTRACT

Objective To investigte the possibility of interventional mechanical thrombectomy dealing with chronic vascular thrombus, and assessing its curative effects. Methods Twenty three cases included 17 males 6 females, and aged from 46 to 80 year with a mean of 64.8. All patients were coinsided with MRA, vascular ultrasound and angiography, in which 12 patients with chronic heart and vascular disease, and 11 patients with serious diabetes. Thrombi were located in iliac artery ( n=9,L=4,R=3 , bilaterals=2), femoral artery( n =2), populiteus artery ( n =2), popliteus artery( n =3), iliac vein ( n =7, L=5,R=2), portal vein ( n =1). The length of thrombi varied from 3 to 8 cm, and the diameter from 5 to 10mm.Filter should be placed in inferior cava vein before venous thrombus treatment ( n =7). Mechanical thrombectomy was undertaken as following ATD ( n=9, Vein=7), PTD( n =2), and Oasis( n =1). After guide wire passing through thrombus segment, Oasis was inserted for remove thrombus. Urokinase (500 000U) was usually administered for catheter directed thombolysis before/during mechanical thrombectomy. Stent should be placed in the segment if stenosis was confirmed after thrombectomy angiography. Drugs were used after thrombectomy including thromboyltic drug, heparinzed anticoagulation and changing microcirculation. Vascular ultrasound, reconstruction CTA and clinical follow up had all been carried out. Results 12 cases (85.7) were undergone successfully thrombectomy. One case failured with portal vein thrombus formation, the other with multiple segments involvement in femoral artery was treated by combined ATD and Oasis. Sy mptoms of 15 cases were either released or disappared, including ischemia, swelling and motion limitations. The patency shown by vascular ultrasound follow up were 100% in three months, 85.4% in six months, 73.2% in twelve months, with simultaneously blood flow improvement to normal and obviously corrected 76.5%,65.4% 60.1% in 3,6,12 month respectively.Conclusions Interventional mechanical thrombectomy is a new choice of treating chronic vascular thrombus with its direct curative effects, but still needs long term follow up.