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Semptomatik Subakut İliofemoral Derin Ven Trombozunun Farmakomekanik Trombektomi ile Endovasküler Tedavisi: Tek Merkez Tedavi Sonuçlarımız

Yıl 2022, Cilt: 17 Sayı: 3, 36 - 42, 02.11.2022
https://doi.org/10.17517/ksutfd.938603

Öz

Özet
Amaç: Bu çalışmada subakut iliofemoral derin ven trombozu (DVT) tanısıyla farmakomekanik trombektomi (FMT) yöntemi ile tedavi edilen hastalarda tedavinin etkinliğini değerlendirmeyi ve 6 aylık sonuçlarımızı sunmayı amaçladık.
Gereç ve Yöntemler: Çalışmaya semptomların başlangıcından itibaren geçen süre 15-28 gün olan, fizik muayenesinde uyluk veya bacakta şişlik, ağrı semptomları olan, renkli doppler ultrasonografide (RDUS) iliofemoral derin venlerde çap artışı ve trombüsü olan hastalar dâhil edildi. Hastalara FMT tedavisi
uygulandı. Tedavi sonrası hastalar 1., 3. ve 6. ayda klinik muayene ve RDUS ile kontrol edildi. Retromboz, sağ-sol uyluk çap farkı, venöz yetmezlik varlığı, vizüel analog skala (VAS) ile ağrı derecesi, Villalta skoru ile postrombotik sendrom (PTS) açısından değerlendirildi.
Bulgular: Hastaların %83.33’ünde DVT sol bacakta idi. Semptomların süresi ortalama 19.3±2.3 gün idi. DVT gelişimi için hastaların %60’ında en az bir risk faktörü mevcuttu. Teknik başarı hastaların % 90’ında sağlandı. İşlem sonrası hastaların %10’unda erken dönemde girişim yerinde kanama veya hematom
gözlendi. Hastaların hiçbirinde cerrahi onarım gerektiren vasküler yaralanma veya psödoanevrizma, major sistemik komplikasyon veya mortalite gelişmedi.
Semptom süresi ile kullanılan doku plazminojen aktivatörü (tPA) dozu, trombüs çıkarılma derecesi, teknik başarı ve retromboz arasında istatistiksel olarak anlamlı ilişki saptanmadı (p>0.05). Tüm hastaların; DVT olan bacak ile olmayan bacak arasındaki sağ-sol çap farklarının, VAS skorlarının, Villalta skorlarının
1., 3., 6. ay kontrollerinde istatistiksel olarak anlamlı düşüş izlendi (p< 0.001). Villalta semptom skorlarındaki düşüş ile teknik başarı arasında anlamlı ilişki saptandı (p=0.002).

Destekleyen Kurum

Bulunmamaktadır

Kaynakça

  • Semba CP, Dake MD. Iliofemoral deep venous thrombosis: Aggressive therapy with catheter directed thrombolysis. Radiol. 1994;191:487-494.
  • Vedantham S, Sista AK, Klein SJ, Nayak L, Razavi MK, Kalva SP et al. Quality improvement guidelines for the treatment of lower extremity deep venous thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol. 2014;25:1317-1325.
  • Enden T, Haig Y, Klow NE, Slagsvold CE, Sandvik L, Ghanima W et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): A randomised controlled trial. Lancet. 2012;379:31–38.
  • Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315–352.
  • Scarvelis D, Wells PS. Diagnosis and treatment of deep vein thrombosis. CMAJ. 2006;175(9):1087-1092.
  • Camerota AJ, Paolini D. Treatment of acute iliofemoral deep venous thrombosis: A strategy of thrombus removal. Eur J Vasc Endovasc Surg. 2007;33(3):351–356.
  • Delis KT, Bountouroglou D, Mansfield AO. Venous claudication in iliofemoral thrombosis: long-term effects on venous hemodynamics, clinical status, and quality of life. Ann Surg. 2004;239(1):118-126.
  • Bozyaka H, Koçyiğit A. Periferik arteriyel ve venöz trombozların tedavisinde girişimsel radyoloji. Trd Sem. 2015;3:277-286. 9.Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH. Catheter-directed thrombolysis of lower extremity deep vein thrombosis: Report of a multicenter registry. Radiol. 1999;211:39–49.
  • Haig Y, Enden T, Slagsvold CE, Sandvik L, Sandset PM, Kløw NE. Determinants of early and long-term efficacy of catheter-directed thrombolysis in proximal deep vein thrombosis. J Vasc Interv Radiol. 2013;24:17–24.
  • Wong PC, Chan YC, Law Y, Cheng SWK. Percutaneous mechanical thrombectomy in the treatment of acute iliofemoral deep vein thrombosis: A systematic review. Hong Kong Med J. 2019;25(1):48-57.
  • Comerota AJ, Kearon C, Gu CS, Julian JA, Goldhaber SZ, Kahn SR et al. Endovascular thrombus removal for acute iliofemoral deep vein thrombosis. Circulation. 2019;139(9):1162–1173.
  • Song XJ, Liu ZL, Zeng R, Liu CW, Ye W. The efficacy and safety of angiojet rheolytic thrombectomy in the treatment of subacute deep venous thrombosis in lower extremity. Ann Vasc Surg. 2019;58(2):295-301.
  • MKW, Stahlhoff S, Młyńczak K, Golicki D, Gagne P, Razavi MK et al. Endovascular mechanical thrombectomy versus thrombolysis in patients with iliofemoral deep vein thrombosis-A systematic review and Meta-analysis. Vasa. 2021;50(1):59-67.
  • Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):22–30.
  • Brandjes DP, Buller HR, Heijboer H, Huisman MV, Rijk M, Jagt H et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet. 1997;349:759-762.
  • Dogancı S, Erol G, Kaya E, Kadan M, Demirkılıç U. İliofemoral derin ven trombozunda ultrasonik katater ile trombolitik tedavi deneyimi. Damar Cer Derg. 2012;21(2):192-196.
  • Karthikesalingam A, Young EL, Hinchliffe RJ, Loftus IM, Thompson MM, Holt PJE. A systematic review of percutaneous mechanical thrombectomy in the treatment of deep venous thrombosis. Eur J Vasc Endovasc Surg. 2011;41(4):554-465.
  • Vedantham S, Goldhaber SZ, Julian JA, Kahn SR, Jaff MR, Cohen DJ et al. Pharmacomechanical catheter-directedthrombolysis for deep-vein thrombosis. N Engl J Med. 2017;377(23):2240-2252.
  • Xu YD, Zhong BY, Yang C, Cai XS, Hu B, Wang XY et al. Comparison of catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy for subacute iliofemoral deep vein thrombosis. Phlebol. 2020;35(8):589-596.
  • Vedantham S, Thorpe PE, Cardella JF, Grassi CJ, Patel NH, Ferral H et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol. 2009;20(7 suppl):227-239.
  • .Lin PH, Zhou W, Dardik A, Mussa F, Kougias P, Hedayati N et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg 2006;192(6):782-788.
  • Oğuzkurt L, Özkan U, Gülcan Ö, Koca N, Gür S. Endovascular treatment of acute and subacute iliofemoral deep venous thrombosis by using manual aspiration thrombectomy: Long-term results of 139 patients in a single center. Diagn Interv Radiol. 2012;18(4):410–416.
  • Alesh I, Kayali F, Stein PD. Catheter-directed thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: A systematic review. Catheter Cardiovasc Interv. 2007;70(1):143-148.
  • Vedantham S, Vesely TM, Parti N, Darcy M, Hovsepian DM, Picus D. Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy. J Vasc Interv Radiol. 2002;13(10):1001-1008.
  • Delomez M, Beregi JP, Willoteaux S, Bauchart JJ, Janne d’Othee B, Asseman P et al. Mechanical thrombectomy in patients with deep venous thrombosis. Cardiovasc Intervent Radiol. 2001;24(1):42-48.
  • Zhang X, Ren Q, Jiang X, Sun J, Gong J, Tang B et al. A prospective randomized trial of catheter-directed thrombolysis with additional balloon dilatation for iliofemoral deep venous thrombosis: A single-center experience. Cardiovasc Intervent Radiol. 2014;37(4):958-968.
  • Ly B, Njaastad AM, Sandbaek G, Solstrand R, Rosales A, Slagsvold CE. Catheter directed thrombolysis of iliofemoral venous thrombosis. Tidsskr Nor Laegeforen. 2004;124(4):478–480.
  • Soosainathan A, Moore HM, Gohel MS, Davies AH. Scoring systems for the post-thrombotic syndrome. J Vasc Surg 2013;57(1):254-261.
  • Vedantham S, Goldhaber SZ, Kahn SR, Julian J, Magnuson E, Jaff MR et al. Rationale and design of the ATTRACT Study: A multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J. 2013(4);165:523-530.

Endovascular Treatment of Symptomatic Subacute Iliofemoral Deep Vein Thrombosis with Pharmacomechanical Thrombectomy: Our Single Center Treatment Results

Yıl 2022, Cilt: 17 Sayı: 3, 36 - 42, 02.11.2022
https://doi.org/10.17517/ksutfd.938603

Öz

Abstract

Objective: In this study, we aimed to evaluate the efficacy of the treatment and present our 6-month results in patients treated with pharmacomechanical thrombectomy (FMT) with the diagnosis of subacute iliofemoral deep vein thrombosis (DVT).
Material and Methods: Patients with 15-28 days from the onset of symptoms, swelling in the thigh or leg on physical examination, pain symptoms, and increased diameter and thrombus in the iliofemoral deep veins in color doppler ultrasonography (RDUS) were included in the study. FMT treatment was applied
to the patients. Post-treatment patients 1., 3. and at 6. months, clinical examination and color Doppler ultrasonography (RDUS) were checked. Presence of re-thrombosis, right-left thigh diameter difference, presence of venous insufficiency, pain degree with visual analog scale (VAS), and post-thrombotic syndrome (PTS) were evaluated with Villalta score.
Results: DVT was in the left leg in 83.33% of the patients. The duration of the symptoms was 19.3±2.3 days on average. Sixty percent of the patients had at least one risk factor for the development of DVT. Technical success was achieved in 90% of the patients. In the early period, bleeding or hematoma at the
intervention site was observed in 10% of the patients after the procedure. None of the patients developed vascular injury or pseudoaneurysm requiring surgical repair, major systemic complications or mortality. There was no statistically significant relationship between symptom duration and tissue plasminogen activator (tPA) dose used, degree of thrombus removal, technical success and rethrombosis (p> 0.05).
All patients; there was a statistically significant decrease in the right-left diameter differences between the leg with DVT and the leg without the leg, VAS scores, and Villalta scores at the 1st, 3rd, and 6th month controls (p<0.001). There was a significant correlation between the decrease in Villalta symptom
scores and technical success (p=0.002).
Conclusion: In patients with subacute DVT, FMT is an effective treatment method because it can reduce the risk of PTS with complaints of pain and swelling in the early clinical period.

Kaynakça

  • Semba CP, Dake MD. Iliofemoral deep venous thrombosis: Aggressive therapy with catheter directed thrombolysis. Radiol. 1994;191:487-494.
  • Vedantham S, Sista AK, Klein SJ, Nayak L, Razavi MK, Kalva SP et al. Quality improvement guidelines for the treatment of lower extremity deep venous thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol. 2014;25:1317-1325.
  • Enden T, Haig Y, Klow NE, Slagsvold CE, Sandvik L, Ghanima W et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): A randomised controlled trial. Lancet. 2012;379:31–38.
  • Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315–352.
  • Scarvelis D, Wells PS. Diagnosis and treatment of deep vein thrombosis. CMAJ. 2006;175(9):1087-1092.
  • Camerota AJ, Paolini D. Treatment of acute iliofemoral deep venous thrombosis: A strategy of thrombus removal. Eur J Vasc Endovasc Surg. 2007;33(3):351–356.
  • Delis KT, Bountouroglou D, Mansfield AO. Venous claudication in iliofemoral thrombosis: long-term effects on venous hemodynamics, clinical status, and quality of life. Ann Surg. 2004;239(1):118-126.
  • Bozyaka H, Koçyiğit A. Periferik arteriyel ve venöz trombozların tedavisinde girişimsel radyoloji. Trd Sem. 2015;3:277-286. 9.Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH. Catheter-directed thrombolysis of lower extremity deep vein thrombosis: Report of a multicenter registry. Radiol. 1999;211:39–49.
  • Haig Y, Enden T, Slagsvold CE, Sandvik L, Sandset PM, Kløw NE. Determinants of early and long-term efficacy of catheter-directed thrombolysis in proximal deep vein thrombosis. J Vasc Interv Radiol. 2013;24:17–24.
  • Wong PC, Chan YC, Law Y, Cheng SWK. Percutaneous mechanical thrombectomy in the treatment of acute iliofemoral deep vein thrombosis: A systematic review. Hong Kong Med J. 2019;25(1):48-57.
  • Comerota AJ, Kearon C, Gu CS, Julian JA, Goldhaber SZ, Kahn SR et al. Endovascular thrombus removal for acute iliofemoral deep vein thrombosis. Circulation. 2019;139(9):1162–1173.
  • Song XJ, Liu ZL, Zeng R, Liu CW, Ye W. The efficacy and safety of angiojet rheolytic thrombectomy in the treatment of subacute deep venous thrombosis in lower extremity. Ann Vasc Surg. 2019;58(2):295-301.
  • MKW, Stahlhoff S, Młyńczak K, Golicki D, Gagne P, Razavi MK et al. Endovascular mechanical thrombectomy versus thrombolysis in patients with iliofemoral deep vein thrombosis-A systematic review and Meta-analysis. Vasa. 2021;50(1):59-67.
  • Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):22–30.
  • Brandjes DP, Buller HR, Heijboer H, Huisman MV, Rijk M, Jagt H et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet. 1997;349:759-762.
  • Dogancı S, Erol G, Kaya E, Kadan M, Demirkılıç U. İliofemoral derin ven trombozunda ultrasonik katater ile trombolitik tedavi deneyimi. Damar Cer Derg. 2012;21(2):192-196.
  • Karthikesalingam A, Young EL, Hinchliffe RJ, Loftus IM, Thompson MM, Holt PJE. A systematic review of percutaneous mechanical thrombectomy in the treatment of deep venous thrombosis. Eur J Vasc Endovasc Surg. 2011;41(4):554-465.
  • Vedantham S, Goldhaber SZ, Julian JA, Kahn SR, Jaff MR, Cohen DJ et al. Pharmacomechanical catheter-directedthrombolysis for deep-vein thrombosis. N Engl J Med. 2017;377(23):2240-2252.
  • Xu YD, Zhong BY, Yang C, Cai XS, Hu B, Wang XY et al. Comparison of catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy for subacute iliofemoral deep vein thrombosis. Phlebol. 2020;35(8):589-596.
  • Vedantham S, Thorpe PE, Cardella JF, Grassi CJ, Patel NH, Ferral H et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol. 2009;20(7 suppl):227-239.
  • .Lin PH, Zhou W, Dardik A, Mussa F, Kougias P, Hedayati N et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg 2006;192(6):782-788.
  • Oğuzkurt L, Özkan U, Gülcan Ö, Koca N, Gür S. Endovascular treatment of acute and subacute iliofemoral deep venous thrombosis by using manual aspiration thrombectomy: Long-term results of 139 patients in a single center. Diagn Interv Radiol. 2012;18(4):410–416.
  • Alesh I, Kayali F, Stein PD. Catheter-directed thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: A systematic review. Catheter Cardiovasc Interv. 2007;70(1):143-148.
  • Vedantham S, Vesely TM, Parti N, Darcy M, Hovsepian DM, Picus D. Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy. J Vasc Interv Radiol. 2002;13(10):1001-1008.
  • Delomez M, Beregi JP, Willoteaux S, Bauchart JJ, Janne d’Othee B, Asseman P et al. Mechanical thrombectomy in patients with deep venous thrombosis. Cardiovasc Intervent Radiol. 2001;24(1):42-48.
  • Zhang X, Ren Q, Jiang X, Sun J, Gong J, Tang B et al. A prospective randomized trial of catheter-directed thrombolysis with additional balloon dilatation for iliofemoral deep venous thrombosis: A single-center experience. Cardiovasc Intervent Radiol. 2014;37(4):958-968.
  • Ly B, Njaastad AM, Sandbaek G, Solstrand R, Rosales A, Slagsvold CE. Catheter directed thrombolysis of iliofemoral venous thrombosis. Tidsskr Nor Laegeforen. 2004;124(4):478–480.
  • Soosainathan A, Moore HM, Gohel MS, Davies AH. Scoring systems for the post-thrombotic syndrome. J Vasc Surg 2013;57(1):254-261.
  • Vedantham S, Goldhaber SZ, Kahn SR, Julian J, Magnuson E, Jaff MR et al. Rationale and design of the ATTRACT Study: A multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J. 2013(4);165:523-530.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Hasan Gündoğdu 0000-0003-0858-7304

İbrahim Duzcan 0000-0002-3909-0328

Medeni Arpa 0000-0001-8321-4829

Erken Görünüm Tarihi 1 Kasım 2022
Yayımlanma Tarihi 2 Kasım 2022
Gönderilme Tarihi 17 Mayıs 2021
Kabul Tarihi 30 Haziran 2021
Yayımlandığı Sayı Yıl 2022 Cilt: 17 Sayı: 3

Kaynak Göster

AMA Gündoğdu H, Duzcan İ, Arpa M. Semptomatik Subakut İliofemoral Derin Ven Trombozunun Farmakomekanik Trombektomi ile Endovasküler Tedavisi: Tek Merkez Tedavi Sonuçlarımız. KSÜ Tıp Fak Der. Kasım 2022;17(3):36-42. doi:10.17517/ksutfd.938603