Impact of the Result of Continued Thrombolysis After Stenting Following Pharmacomechanical Thrombectomy for Iliofemoral Deep Vein Thrombosis-A Retrospective Study.

OBJECTIVE: The aim of this study is to compare the procedure and treatment outcomes of using either direct stenting alone following pharmacomechanical thrombectomy or continued catheter-directed thrombolysis after stenting for treatment of acute left iliofemoral deep vein thrombosis while clot removal degree achieved grade III. METHODS: From March 2018 to May 2019, 82 patients who underwent iliac venous stenting for treatment of acute left iliofemoral deep vein thrombosis with iliac vein stenosis after pharmacomechanical thrombectomy therapy using the AngioJet system while Clot removal degree achieved grade III were divided into two groups: Direct stenting alone group (n = 39) and continued catheter-directed thrombolysis after stenting group (n = 43). Comparisons were made regarding the treatment outcomes, stent patency rate, and Villalta scale between these two groups. RESULTS: No serious perioperative complications occurred. The mean urokinase dose and hospitalization time in the stenting alone group and continued catheter-directed thrombolysis after the stenting group were 0.30 million U versus 1.76 ± 0.54 million U and 4.85 ± 0.93 days versus 6.33 ± 1.02 days, (P < .001). In the first 30 days after the operation, there were 3 recurrent episodes of deep vein thrombosis in the stenting alone group (P = 0.064). Each patient has completed at least one year of follow-up, the mean follow-up was 15.95 ± 3.44 months. Overall cumulative stent patency rates were 87.2% in stenting alone group and 97.7% in continued catheter-directed thrombolysis after stenting group at 12months (P = 0.037). The Villalta scores at 12 months had a significant difference between the two groups. The mean Villalta scores in the stenting alone group and continued catheter-directed thrombolysis after the stenting group were 4.44 ± 1.63 and 1.63 ± 1.29, respectively (P < 0.001). CONCLUSION: When the clot removal degree of pharmacomechanical thrombectomy thrombectomy reaches grade III, both stenting alone and continued catheter-directed thrombolysis after stenting are effective treatment modalities. For young patients with low bleeding risk, continued catheter-directed thrombolysis after stenting has a better patency rate and a lower 1-year post-thrombotic syndrome risk and does not increase major bleeding events. However, it may increase the time and costs of hospitalization accordingly.

Endovascular treatment for long segment iliac artery occlusion involving the iliac artery opening.

OBJECTIVE: This retrospective nonrandomized study investigated the outcomes of endovascular therapy for long-segment iliac artery occlusion involving the iliac artery opening. METHODS: During a 5-year period (from Mar 2012 to Mar 2017), 32 patients (two women and 30 men; mean age, 69.0 years; range, 51-90 years) received endovascular therapy, with or without catheter-directed thrombolysis (CDT), for long-segment iliac artery occlusion (mean lesion length, 129.8 mm; range, 74.7-189.3 mm). RESULTS: The technical success rate was 90.6% (29 of 32). The major complication rate was 3.5%, but no in-hospital mortality was recorded. The access site complication rate was 10.3%. The clinical symptoms of 29 patients were significantly improved. All 29 patients were followed up for 6-40 months, with an average of 16.7 ± 10.9 months. The primary patency rates were 96.6 ± 3.4% at 6 months, 86.6 ± 7.3% at 12 months, 79.4 ± 9.6% at 24 months, and 66.2 ± 14.5% at 36 months. CONCLUSIONS: Depending on the characteristics of the disease, endovascular treatment with an individualized, rational choice of approach and with fine-tuning of the operation is a safe and effective treatment for long-term iliac artery occlusion involving the opening of the iliac arteries. Customization of the treatment is also the key to a successful operation and to ensuring good postoperative efficacy.