Abstract：Objective To evaluate the mid- and long-term clinical effects of percutaneous mechanical thrombectomy (PMT) in the treatment of inferior vena cava thrombosis (IVCT). Methods A retrospective cohort study was conducted. A total of 45 patients with inferior vena cava filter implantation and IVCT treated by PMT or anticoagulation in Beijing Jishuitan Hospital from January 2018 to October 2021 were included in this study. The patients included 25 males and 20 females aged 25-78(49.5±14.0) years. They were divided into two groups in accordance with treatment methods: 24 cases in the PMT group and 21 cases in the anticoagulation group. Observation indicators included the following: (1) The thrombectomy effect of PMT in IVCT was observed. (2) The morphological changes in the inferior vena cava in the two groups, including the vascular wall thickening, reference diameter, minimum diameter, and stenosis rate of the inferior vena cava. (3) The Villalta score and incidence of post-thrombosis syndrome (PTS) were compared between the two groups. (4) The correlation between the Villalta score and the stenosis rate of the inferior vena cava were analyzed. Results Inferior vena cava filters were all successfully removed from 45 patients. Follow-up for 194-658 days showed that deep vein thrombosis or IVCT did not recur. (1) The PMT operations were successful, and IVCT clearance reached grade Ⅲ in 4 cases, and grade Ⅱ in 20 cases. (2) No significant difference was found between the two groups in terms of age, sex, body mass index, filter implantation time, and follow-up time (all P values >0.05). The vascular wall thickening of the inferior vena cava was 67% (16/24) and 86% (18/21), the reference diameters was (16.1±2.1) mm and (15.8±3.4) mm respectively in the two groups without significant differences (χ2=2.20,t=0.33; all P values >0.05). In the PMT and anticoagulation groups, the minimum diameters of the inferior vena cava were 13.1(10.2, 15.3) and 10.2(0,13.5) mm, respectively, and the stenosis rates of the inferior vena cava were 18.5(10.1, 32.4)% and 32.2(18.5,100.0)%, respectively, with statistically significant differences (Z=2.28, 2.60; all P values <0.05).(3) In the PMT and anticoagulation groups, the Villalta scores were 3.0(2.0,4.0) and 4.0(2.5, 8.5), respectively, with statistically significant differences (Z=2.00, P=0.045), and the incidences of PTS were 25% (6/24) and 43% (9/21), respectively, without significant differences (χ2=1.61, P=0.205). (4) The Villalta score was moderately correlated with the stenosis rate of the inferior vena cava (rs=0.34, P=0.012). Conclusion Compared with anticoagulation therapy, PMT for IVCT can reduce the stenosis of the inferior vena cava, the patient's Villalta score, and improve the patient's quality of life in the mid- and long-term.
Huynh N, Fares WH, Brownson K, et al.Risk factors for presence and severity of pulmonary embolism in patients with deep venous thrombosis[J]. J Vasc Surg Venous Lymphat Disord, 2018,6(1):7-12. DOI: 10.1016/j.jvsv.2017.08.015
[2]
Expert Panel on Interventional Radiology: Minocha J, Smith AM, Kapoor BS, et al. ACR appropriateness criteria® radiologic management of venous thromboembolism-inferior vena cava filters[J]. J Am Coll Radiol, 2019,16(5S):S214-S226. DOI: 10.1016/j.jacr.2019.02.010
[3]
Golowa Y, Warhit M, Matsunaga F, et al.Catheter directed interventions for inferior vena cava thrombosis[J]. Cardiovasc Diagn Ther, 2016,6(6):612-622. DOI: 10.21037/cdt.2016.11.09
[4]
Kohi MP, Kohlbrenner R, Kolli KP, et al.Catheter directed interventions for acute deep vein thrombosis[J]. Cardiovasc Diagn Ther, 2016,6(6):599-611. DOI: 10.21037/cdt.2016.11.20
[5]
Alkhouli M, Morad M, Narins CR, et al.Inferior vena cava thrombosis[J]. JACC Cardiovasc Interv, 2016,9(7):629-643. DOI: 10.1016/j.jcin.2015.12.268
Jia Z, Fuller TA, McKinney JM, et al. Utility of retrievable inferior vena cava filters: a systematic literature review and analysis of the reasons for nonretrieval of filters with temporary indications[J]. Cardiovasc Intervent Radiol, 2018,41(5):675-682. DOI: 10.1007/s00270-018-1880-9
[9]
Bikdeli B, Jiménez D, Kirtane AJ, et al.Systematic review of efficacy and safety of retrievable inferior vena caval filters[J]. Thromb Res, 2018,165:79-82. DOI: 10.1016/j.thromres.2018.03.014
[10]
Arabi M, Krishnamurthy V, Cwikiel W, et al.Endovascular treatment of thrombosed inferior vena cava filters: techniques and short-term outcomes[J]. Indian J Radiol Imaging, 2015,25(3):233-238. DOI: 10.4103/0971-3026.161436
[11]
Broderick C, Watson L, Armon MP. Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb[J]. Cochrane Database Syst Rev, 2021,1(1):CD002783. DOI: 10.1002/14651858.CD002783.pub5
[12]
Casanegra AI, McBane RD, Bjarnason H. Intervention radiology for venous thrombosis: early thrombus removal using invasive methods[J]. Br J Haematol, 2017,177(2):173-184. DOI: 10.1111/bjh.14581
蒋鹏, 李金勇, 程志远, 等. 精准溶栓及机械性血栓清除术在急性深静脉血栓形成治疗中的应用[J].中国血管外科杂志(电子版),2018,10(1):24-26. DOI: 10.3969/j.issn.1674-7429.2018.01.006Jiang P, Li JY, Cheng ZY, et al.Clinical application of precision thrombolysis and percutaneous mechanical thrombectomy in the treatment of acute deep venous thrombosis[J]. Chinese Journal of Vascular Surgery (Electronic Version),2018,10(1) :24-26. DOI: 10.3969/j.issn.1674-7429.2018.01.006
[15]
程志远, 贾伟, 田轩, 等. 下腔静脉滤器回收后血管形态改变的CT静脉造影研究[J].中华解剖与临床杂志,2020,25(3):272-277. DOI: 10.3760/cma.j.cn101202-20190830-00271Cheng ZY, Jia W, Tian X, et al.CT venography study on vascular morphological changes after inferior vena cava filter retrieval[J]. Chin J Anat Clin,2020,25(3):272-277. DOI: 10.3760/cma.j.cn101202-20190830-00271
[16]
Metz AK, Diaz JA, Obi AT, et al.Venous thrombosis and post-thrombotic syndrome: from novel biomarkers to biology[J]. Methodist Debakey Cardiovasc J, 2018,14(3):173-181. DOI: 10.14797/mdcj-14-3-173.
2023, Vol. 28 
