Clinical Analysis of Catheter-Directed Thrombolysis Combined with Vena Cava Filter for Deep Venous Thrombosis of Lower Extremity_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHENG Jianghua , WU Guo , ZHU Yanbin , CHEN Xinglin , CHEN Kai.

Department of Vascular Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province， China;

Corresponding author：

Keywords：

Lower extremity deep venous thrombosis; Vena cava filter; Catheter-directed thrombolysis; Therapeutic effect

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Objective To explore the therapeutic effect of catheter-directed thrombolysis combined with vena cava filter on deep venous thrombosis (DVT) of lower extremity.
Methods The clinical data of 65 patients with DVT of lower extremities from January 2008 to August 2009 were analyzed retrospectively, whose course of diseases were not more than 7 d and clinical type included central type and mixed type. Thirty-two cases were treated with catheter-directed thrombolysis combined with vena cava filter, while administrating treatment of anticoagulation and activating blood circulation to dissipate blood stasis, which were named as study group. Thirty-three cases were treated traditionally with thrombolysis, anticoagulation, and activating blood circulation to dissipate blood stasis, which were named as control group. The course of therapy was continued 10-14 d, then the efficacy in two groups patients was evaluated.
Results It was (7.35±1.42) cm that circumference difference before treatment between affected extremties and unaffected extremties in study group, which of 3, 7, and 14 d after treatment was (4.21±1.12) cm， (2.87±0.98) cm, and (1.22±1.02) cm, respectively. Circumference difference between before and after treatment had significant difference in study group (P lt;0.01). It was (6.97±1.27) cm that circumference difference before treatment between affected extremties and unaffected extremties in control group, which of 3, 7, and 14 d after treatment was (5.72±1.31) cm, (4.58±0.88) cm, and (3.18±1.24) cm, respectively. Circumference difference between before treatment and 3, 7, and 14 d after treatment had significant difference in control group (P lt;0.05 or P lt;0.01). Circumference difference before treatment in two groups had no significant difference (P gt;0.05). Circumference difference after treatment at different time points in two groups was significantly different, respectively (P lt;0.01). Circumference difference after treatment at different time points in study group was significantly less than that in control group, respectively (P lt;0.01). After 14 d, complete recanalization rate （71.88%, 23/32） and cure rate (71.88%, 23/32) of iliofemoral vein in study group were significant higher than that (36.36%, 12/33) in control group (P lt;0.01). No pulmonary embolism occurred. Conclusion In terms of ideal therapy targets of DVT of lower extremity, the catheterdirected thrombolysis combined with vena cava filter is obviously superior to traditional thrombolysis treatment.

Citation： ZHENG Jianghua,WU Guo,ZHU Yanbin,CHEN Xinglin,CHEN Kai.. Clinical Analysis of Catheter-Directed Thrombolysis Combined with Vena Cava Filter for Deep Venous Thrombosis of Lower Extremity. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(7): 679-682. doi: Copy

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2.	Baldwin ZK, Comerota AJ, Schwartz LB. Catheterdirected thrombolysis for deep venous thrombosis [J]. Vasc Endovasc Surg, 2004; 38 (1): 19.
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13.	Semba CP, Dake MD. Iliofemoral deep venous thrombosis: aggressive therapy with catheterdirected thrombolysis [J]. Radiology, 1994; 191(2): 487494.
14.	蒋劲松, 施敦, 张成武, 等. 抗凝溶栓联合用药治疗急性下肢深静脉血栓 [J]. 浙江实用医学, 2004; 9(6): 391392, 401.
15.	Enden T, Klw NE, Sandvik L, et al. Catheterdirected thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on shortterm patency [J]. J Thromb Haemost, 2009; 7(8): 12681275.
16.	Mewissen MW, Seabrook GR, Meissner MH, et al. Catheterdirected thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry [J]. Radiology, 1999; 211(1): 3949.
17.	张精勇, 金星, 吴学君, 等. 滤器保护下置管溶栓治疗下肢深静脉血栓形成临床总结 [J]. 中国实用外科杂志, 2006; 26(10): 774776.
18.	Comerota AJ, Throm RC, Mathias SD, et al. Catheterdirected thrombolysis for iliofemoral deep venous thrombosis improves healthrelated quality of life [J]. J Vasc Surg, 2000; 32(1): 130137.
19.	Lin PH, Zhou W, Dardik A, et al. Catheterdirect thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis [J]. Am J Surg, 2006; 192(6): 782788.
20.	Alesh I, Kayali F, Stein PD. Catheterdirected thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: a systematic review [J]. Catheter Cardiovasc Interv, 2007; 70(1): 143148.
21.	Kasirajan K, Milner R, Chaikof EL. Combination therapies for deep venous thrombosis [J]. Semin Vasc Surg, 2006; 19(2): 116121.
22.	黄晓钟, 张纪蔚, 梁卫, 等. 介入腔内溶栓治疗急性下肢深静脉血栓形成 [J]. 介入放射学杂志, 2006; 15(10): 592596.
23.	李国剑, 杨国凯, 何晓明, 等. 下腔静脉滤器在治疗下肢深静脉血栓中的应用 [J]. 中国普外基础与临床杂志, 2009; 16(11): 922924.
24.	Greenfild LJ, Proctor MC. Recurrent thromboembolism in patients with vena cava filters [J]. J Vasc Surg, 2001; 33(3): 510514.

1. Barrett J, Hamilton W. Malignancy and deep vein thrombosis [J]. Br J Gen Pract, 2006; 56(532): 886.
2. Baldwin ZK, Comerota AJ, Schwartz LB. Catheterdirected thrombolysis for deep venous thrombosis [J]. Vasc Endovasc Surg, 2004; 38 (1): 19.
3. Lilienfeld DE, Chan E, Ehland J, et al. Mortality from pulmonary embolism in the United States: 1962 to 1984 [J]. Chest, 1990; 98(5): 10671072.
4. Comerota AJ, Kagan SA. Catheterdirected thrombolysis for the treatment of acute iliofemoral deep venous thrombosis [J]. Phlebology, 2000; 15(2): 149155.
5. Saarinen J, Kallio T, Lehto M, et al. The occurrence of the postthrombotic changes after an acute deep venous thrombosis. A prospective twoyear followup study [J]. J Cardiovasc Surg (Torino), 2000; 41(3): 441446.
6. Meissner MH. Thrombolytic therapy for acute deep venous thrombosis and the venous registry [J]. Rev Cardiovasc Med, 2002; 3 Suppl 2: S53S60.
7. Bergqvist D, Lindholm C, Nelzén O. Chronic leg ulcers: the impact of venous disease [J]. J Vasc Surg, 1999; 29(4): 752755.
8. 王玉琦, 史振宇. 我国血管外科的现状与展望 [J]. 中国普外基础与临床杂志, 2008; 15(6): 387389.
9. 马玉奎, 赵纪春, 胡志, 等. 下肢深静脉血栓形成的诊断及综合治疗 [J]. 中国普外基础与临床杂志, 2008; 15(1): 5658.
10. 陈鸿强, 李光新, 许崇恩, 等. 急性下肢深静脉血栓形成的溶栓治疗分析（附126例报告） [J]. 中国普外基础与临床杂志, 2006; 13(6): 665667.
11. 华积德. 现代普通外科学 [M]. 北京: 人民军医出版社, 1999: 287288.
12. 张柏根. 下肢深静脉血栓形成治疗和预后的几个问题 [J]. 中华普通外科杂志, 2006; 21(2): 8183.
13. Semba CP, Dake MD. Iliofemoral deep venous thrombosis: aggressive therapy with catheterdirected thrombolysis [J]. Radiology, 1994; 191(2): 487494.
14. 蒋劲松, 施敦, 张成武, 等. 抗凝溶栓联合用药治疗急性下肢深静脉血栓 [J]. 浙江实用医学, 2004; 9(6): 391392, 401.
15. Enden T, Klw NE, Sandvik L, et al. Catheterdirected thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on shortterm patency [J]. J Thromb Haemost, 2009; 7(8): 12681275.
16. Mewissen MW, Seabrook GR, Meissner MH, et al. Catheterdirected thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry [J]. Radiology, 1999; 211(1): 3949.
17. 张精勇, 金星, 吴学君, 等. 滤器保护下置管溶栓治疗下肢深静脉血栓形成临床总结 [J]. 中国实用外科杂志, 2006; 26(10): 774776.
18. Comerota AJ, Throm RC, Mathias SD, et al. Catheterdirected thrombolysis for iliofemoral deep venous thrombosis improves healthrelated quality of life [J]. J Vasc Surg, 2000; 32(1): 130137.
19. Lin PH, Zhou W, Dardik A, et al. Catheterdirect thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis [J]. Am J Surg, 2006; 192(6): 782788.
20. Alesh I, Kayali F, Stein PD. Catheterdirected thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: a systematic review [J]. Catheter Cardiovasc Interv, 2007; 70(1): 143148.
21. Kasirajan K, Milner R, Chaikof EL. Combination therapies for deep venous thrombosis [J]. Semin Vasc Surg, 2006; 19(2): 116121.
22. 黄晓钟, 张纪蔚, 梁卫, 等. 介入腔内溶栓治疗急性下肢深静脉血栓形成 [J]. 介入放射学杂志, 2006; 15(10): 592596.
23. 李国剑, 杨国凯, 何晓明, 等. 下腔静脉滤器在治疗下肢深静脉血栓中的应用 [J]. 中国普外基础与临床杂志, 2009; 16(11): 922924.
24. Greenfild LJ, Proctor MC. Recurrent thromboembolism in patients with vena cava filters [J]. J Vasc Surg, 2001; 33(3): 510514.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Analysis of Catheter-Directed Thrombolysis Combined with Vena Cava Filter for Deep Venous Thrombosis of Lower Extremity

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