AngioJet机械血栓清除术对急性髂股静脉深静脉血栓患者血栓后综合征长期发生率的影响

Impact of AngioJet mechanical thrombectomy on the long-term incidence of post-thrombotic syndrome in patients with acute iliofemoral deep vein thrombosis

摘要:

背景与目的 血栓后综合征（PTS）是急性髂股静脉深静脉血栓形成（DVT）患者最重要的远期并发症之一。AngioJet机械血栓清除术可实现快速血管再通，但其对PTS长期发生风险的影响尚缺乏充分证据。本研究比较AngioJet机械血栓清除术与传统导管接触性溶栓（CDT）治疗急性髂股静脉DVT的长期疗效与安全性，重点评估其对PTS发生率的影响。方法 回顾性纳入2021年1月—2023年6月收治的急性髂股静脉DVT患者100例（发病时间≤14 d），其中52例接受AngioJet机械血栓清除术（AngioJet组），48例接受CDT治疗（对照组）。主要终点为随访24个月内PTS发生率（Villalta评分≥5或出现静脉性溃疡）；次要终点包括血管再通率、下肢周径差值、生活质量评分（VEINES-QOL）、主要出血事件、血栓复发率及住院时间。采用Kaplan-Meier法比较PTS累积发生率，并通过Cox比例风险模型分析PTS的影响因素。结果 两组基线特征差异无统计学意义（均P>0.05）。AngioJet组即刻血管再通率显著高于对照组（96.15% vs. 64.58%，P<0.001）。24个月累积PTS发生率AngioJet组显著低于对照组（11.54% vs. 37.50%，P<0.05）。AngioJet组在6、12、18和24个月时的下肢周径差值均明显小于对照组，且各随访时间点VEINES-QOL评分均显著更高（均P<0.001）。两组主要出血事件和血栓复发率差异无统计学意义（均P>0.05），但AngioJet组住院时间明显缩短（P<0.05）。多因素Cox分析显示，AngioJet治疗（HR=0.31，P=0.003）和BMI<25 kg/m²（HR=0.38，P=0.012）为PTS发生的独立保护因素，而血栓累及静脉段数为独立危险因素（HR=2.78，P=0.005）。结论 AngioJet机械血栓清除术可显著降低急性髂股静脉DVT患者PTS的长期发生风险，改善患者肢体功能和生活质量，且安全性良好。血栓范围及体质量是影响PTS预后的重要因素。

Abstract:

Background and Aims Post-thrombotic syndrome (PTS) is a major long-term complication in patients with acute iliofemoral deep vein thrombosis (DVT). Although AngioJet mechanical thrombectomy provides rapid venous recanalization, its long-term impact on PTS remains unclear. This study aimed to compare the long-term efficacy and safety of AngioJet mechanical thrombectomy versus catheter-directed thrombolysis (CDT) in patients with acute iliofemoral DVT, with particular focus on the incidence of PTS.Methods A total of 100 patients with acute iliofemoral DVT (symptom onset ≤14 days) treated between January 2021 and June 2023 were retrospectively analyzed. Fifty-two patients underwent AngioJet mechanical thrombectomy (AngioJet group), and 48 received CDT (control group). The primary endpoint was the incidence of PTS within 24 months, defined as a Villalta score ≥5 or venous ulceration. Secondary endpoints included venous patency rate, calf circumference difference, quality of life assessed by the VEINES-QOL questionnaire, major bleeding events, recurrent thrombosis, and length of hospital stay. Kaplan-Meier analysis and Cox proportional hazards models were used for statistical analysis.Results Baseline characteristics were comparable between groups (all P>0.025). The immediate venous recanalization rate was significantly higher in the AngioJet group than in the CDT group (96.15% vs. 64.58%, P<0.001). At 24 months, the cumulative incidence of PTS was significantly lower in the AngioJet group (11.54% vs. 37.50%, P<0.05). The AngioJet group demonstrated significantly smaller calf circumference differences and higher VEINES-QOL scores at all follow-up time points (all P<0.001). No significant differences were observed in major bleeding or recurrent thrombosis (both P>0.05), while hospital stay was significantly shorter in the AngioJet group (P<0.05). No significant differences were observed in major bleeding or recurrent thrombosis (both P>0.05). Multivariate Cox analysis identified AngioJet treatment (HR=0.31, P=0.003) and BMI <25 kg/m² (HR=0.38, P=0.012) as independent protective factors against PTS, whereas the number of involved venous segments was an independent risk factor (HR=2.78, P=0.005).Conclusion AngioJet mechanical thrombectomy significantly reduces the long-term incidence of PTS and improves limb function and quality of life in patients with acute iliofemoral DVT, with an acceptable safety profile. Thrombus extent and body mass index are important determinants of long-term prognosis.