Comparative analysis of clinical efficacy of catheter thrombolysis alone and catheter thrombolysis combined with pigtail catheter crushing thrombus in the treatment of non-chronic deep venous thrombosis
Wang Xiangkui1, Ni Lianghong1, Chen Letian1, Zheng Zhitao1, Lu Ran2, Gao Yong2
1Department of Vascular Surgery, Huaibei Miners General Hospital, Huaibei 235000, China; 2Department of Vascular Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
Abstract：Objective This study aimed to compare the safety and early clinical efficacy of catheter directed thrombolysis (CDT) and CDT combined with pigtail catheter crushing thrombus in the treatment of non-chronic deep venous thrombosis (DVT). Methods A retrospective cohort study was conducted. From January 2020 to December 2021, 55 patients (28 males and 27 females) with non-chronic deep vein thrombosis who underwent endovascular surgery in the Department of Vascular Surgery of Huaibei Miners General Hospital were included, aged 33-83 (65.8±12.4) years. Among them, 34 cases were left lower limb and 21 were right lower limb. The course of disease lasted 1-26 (9.7±5.5) days, including 36 patients in the acute phase and 19 patients in the subacute phase. The patients were divided into two groups in accordance with different treatment schemes. The combined group (27 patients) was treated with CDT combined with pigtail catheter crushing thrombus, and the control group (28 patients) was treated with CDT only. The observation indices, namely, recent clinical efficacy, dosage of urokinase, thrombolytic time, length of hospital stay, and bleeding complications, of the two groups were compared. At 12 months of follow-up, Villalta scale was used to evaluate the severity of post-thrombotic syndrome (PTS) in both groups. Results No significant difference was found in the baseline data between the two groups (all P values >0.05). The technical success rate for all patients was 100%. The recent clinical effective rate was 92.59% (25/27) in the combination group, and the efficacy was grade Ⅰ,Ⅱ,Ⅲ in 2, 9, 16 patients, respectively, better than the 67.86% (19/28) in the control group, and the efficacy was grade Ⅰ,Ⅱ,Ⅲ in 9, 10, 9 patients, respectively, and the difference was statistically significant (Z=-2.42, P=0.016). The dosage of urokinase, the thrombolytic time, and the length of hospital stay in the combination group were (1 882±415)×103 U, (3.7±0.7) days, and (7.9±1.2) days, respectively, lower than the (2 621±340)×103 U, (6.6±0.6) days, and (14.0±2.0) days in the control group, respectively. The differences were statistically significant (t=7.23, 17.10, and 13.85, respectively; all P values <0.001). Postoperative bleeding complications occurred in two patients in the combination group and four patients in the control group, and the difference was not statistically significant (χ2=0.15, P=0.699). At 12 months of follow-up, seven patients in the combination group had PTS, including two mild cases, three moderate cases, and two severe cases. Meanwhile, PTS occurred in 10 patients in the control group, including three mild cases, three moderate cases, and four severe cases. No significant difference was observed between the two groups (Z=-0.81, P=0.416). All patients were followed up for 12 months after the operation. Conclusion For patients with non-chronic lower extremity DVT, CDT alone and CDT combined with pigtail catheter crushing thrombus are safe and effective. However, the early clinical efficiency of the combined regimen is higher in the combination group than in the control group. The treatment time is shortened, and the dosage of thrombolytic drugs is reduced. As a result, the treatment cost is reduced, and the combined regimen is suitable for popularization in primary hospitals.
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Wang Xiangkui, Ni Lianghong, Chen Letian, Zheng Zhitao, Lu Ran, Gao Yong. Comparative analysis of clinical efficacy of catheter thrombolysis alone and catheter thrombolysis combined with pigtail catheter crushing thrombus in the treatment of non-chronic deep venous thrombosis. Chinese Journal of Anatomy and Clinics, 2022, 27(11): 786-791.
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2022, Vol. 27 
