机械血栓清除装置治疗下肢深静脉血栓形成：应用现状与展望

Mechanical thrombectomy for lower extremity deep vein thrombosis: current evidence and future perspectives

摘要:

下肢深静脉血栓形成（DVT）急性期可导致肢体严重肿胀及肺栓塞，危及患者生命，慢性期则易进展为深静脉血栓形成后综合征（PTS），显著影响患者生活质量。近年来，随着血管腔内技术的发展，经皮机械血栓清除（PMT）在DVT治疗中的应用迅速增加，被认为是降低中重度PTS发生率的重要手段之一。目前临床应用的PMT器材主要包括流体力学类、负压抽吸类、取栓支架类、血栓旋切类及超声导管辅助溶栓装置等，其清栓机制、适用人群及技术特点各不相同。现有研究显示，各类PMT装置在短期内均具有较好的安全性和血栓清除效果，但在急性、亚急性及慢性早期DVT中的疗效差异、器材选择策略及对静脉瓣膜功能的长期影响仍缺乏高质量循证证据。本文结合最新指南及国内外研究进展，系统阐述不同类型PMT器材的技术原理、临床应用特点及适用场景，分析当前存在的问题，并对未来研究方向及器材发展趋势进行展望，以期为DVT的个体化治疗提供参考。

Abstract:

Lower extremity deep vein thrombosis (DVT) is a common vascular disorder that may cause severe limb swelling and pulmonary embolism in the acute phase, and can progress to post-thrombotic syndrome (PTS) in the chronic stage, leading to long-term impairment of patients' quality of life. With advances in endovascular techniques, percutaneous mechanical thrombectomy (PMT) has gained increasing attention as an early intervention strategy for DVT and is considered effective in reducing the incidence of moderate-to-severe PTS. Currently available PMT devices can be broadly classified into rheolytic, aspiration-based, stent retriever-based, rotational thrombectomy, and ultrasound-assisted thrombolysis systems, each with distinct mechanisms and clinical applications. Although short-term safety and efficacy of these devices have been preliminarily demonstrated, their comparative effectiveness in acute, subacute, and early chronic DVT, optimal device selection, and long-term impact on venous valve function remain uncertain due to the lack of high-quality evidence. This review summarizes the principles, technical features, and clinical applications of different PMT devices based on current guidelines and recent studies, discusses existing challenges, and outlines future research directions and device development trends, aiming to provide a reference for individualized treatment of DVT.