机械血栓清除术治疗老年患者下肢深静脉血栓的疗效与安全性

Efficacy and safety of mechanical thrombectomy for the treatment of lower extremity deep vein thrombosis in elderly patients

摘要:

背景与目的 老年患者下肢深静脉血栓形成（DVT）发病率高，合并基础疾病多，单纯抗凝或溶栓治疗存在疗效受限及出血风险增加等问题。经皮机械血栓清除术（PMT）可在减少溶栓药物用量的同时快速清除血栓，但其在老年急性下腔静脉和（或）髂股静脉DVT患者中的临床疗效与安全性仍需进一步评估。本研究旨在探讨PMT治疗老年急性下腔静脉和（或）髂股静脉DVT的有效性与安全性。方法 回顾性分析2017年1月—2024年12月于首都医科大学附属北京积水潭医院血管外科接受PMT治疗的70例老年（≥65岁）急性下腔静脉和（或）髂股静脉DVT患者的临床资料。所有患者术前均植入下腔静脉滤器，采用AngioJet或Straub Aspirex系统行PMT，并根据术中情况联合导管取栓（MAT）、导管接触性溶栓（CDT）、球囊扩张及支架植入。评估技术成功率、血栓清除效果、围手术期并发症、滤器取出情况，并随访1年，观察血栓复发、血栓后综合征（PTS）及目标静脉通畅率。结果 所有患者均顺利完成PMT，技术成功率为100%。综合血栓清除成功率（Ⅱ级+Ⅲ级）为88.57%。围手术期未发生症状性肺栓塞。大出血发生率为1.43%，小出血发生率为5.71%，血红蛋白尿发生率为15.71%，均经处理后缓解。62例患者尝试取出滤器，取出成功率为100%，中位滤器留置时间为58.5（20~84.25）d。术后1年内血栓复发率为2.86%，PTS发生率为21.43%，目标静脉通畅率为82.86%。结论 对于老年急性下腔静脉和（或）髂股静脉DVT患者，PMT联合个体化的辅助腔内治疗可在较低出血风险下实现有效血栓清除，具有良好的安全性和中期疗效。

Abstract:

Background and Aims Elderly patients with deep vein thrombosis (DVT) are at high risk for bleeding and often have limited therapeutic options with conventional anticoagulation or thrombolytic therapy. Percutaneous mechanical thrombectomy (PMT) enables rapid thrombus removal while reducing thrombolytic drug exposure; however, its clinical efficacy and safety in elderly patients with acute inferior vena cava and/or iliofemoral DVT remain to be clarified. This study aimed to evaluate the effectiveness and safety of PMT in this patient population.Methods Clinical data of 70 elderly patients (≥65 years) with acute inferior vena cava and/or iliofemoral DVT treated with PMT between January 2017 and December 2024 were retrospectively analyzed. All patients underwent inferior vena cava filter implantation prior to PMT. AngioJet or Straub Aspirex systems were used, with adjunctive endovascular procedures including manual aspiration thrombectomy (MAT), catheter-directed thrombolysis (CDT), balloon angioplasty, and stent implantation as indicated. Technical success, thrombus clearance, perioperative complications, filter retrieval outcomes, and 1-year follow-up results-including recurrence, post-thrombotic syndrome (PTS), and target vein patency-were assessed.Results PMT was successfully performed in all patients, yielding a technical success rate of 100%. The overall thrombus clearance success rate (grade Ⅱ+Ⅲ) was 88.57%. No symptomatic pulmonary embolism occurred. Major bleeding was observed in 1.43% of patients, minor bleeding in 5.71%, and hemoglobinuria in 15.71%, all of which resolved with appropriate management. Filter retrieval was attempted in 62 patients, with a 100% success rate and a median dwell time of 58.5 (20-84.25) d. At 1-year follow-up, the recurrence rate was 2.86%, the incidence of PTS was 21.43%, and the target vein patency rate was 82.86%.Conclusion PMT combined with individualized adjunctive endovascular therapy is a safe and effective treatment option for elderly patients with acute inferior vena cava and/or iliofemoral DVT, achieving satisfactory thrombus clearance with acceptable complication rates.