Advances of percutaneous mechanical thrombectomy in the treatment of lower extremity deep vein thrombosis

doi:10.3877/cma.j.issn.1674-0793.2021.01.018

Abstract

Abstract:

The incidence of venous thromboembolism is gradually increasing. More than 70% of patients receiving standard anticoagulation treatment suffered from post-thrombotic syndrome (PTS), which will seriously reduce the quality of life and increase the economic burden. Therefore, rapid removal of thrombus, restoration of venous flow and reduce the incidence of PTS have become the focus of clinical research in recent years. The current treatment methods include systemic thrombolysis, catheter-directed thrombolysis (CDT), surgical thrombectomy, thrombus aspiration, percutaneous mechanical thrombectomy (PMT), et al. PMT can rapidly remove acute or subacute thrombus through different physical methods and reduce the use of thrombolytic drugs. Although there is no high-quality evidence to prove that PMT has better safety and effectiveness than other treatments, it provides more choices for clinicians to achieve the best clinical effects. This paper aims to summarize the basic principles, advantages and limitations of PMT.

Key words: Venous thrombosis, Mechanical thrombectomy, Post-thrombotic syndrome, Treatment

Guanqiang Li, Yuan Sun, Xicheng Zhang. Advances of percutaneous mechanical thrombectomy in the treatment of lower extremity deep vein thrombosis[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(01): 70-74.

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URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2021.01.018

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References 30

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分类	设备	原理	特点	局限性
旋转涡轮式血栓消融器	Amplatz系统	叶轮旋转、粉碎血栓	操作简便，手术时间短	无导丝引导，粉碎血细胞和血栓物质再次进入循环，易出现肺栓塞、血管损伤、溶血
	Trellis系统	球囊阻断，震动导丝溶栓	隔离血栓，避免远端栓塞	易损伤血管壁
	Cleaner系统	柔性S形导丝破碎血栓	柔性导丝减少血管壁损伤	二者通过导丝将血栓破坏，无远端保护装置，易出现肺栓塞
	Aspirex系统	旋转式线控装置溶栓	头部本身不旋转，减少损伤血管风险	二者通过导丝将血栓破坏，无远端保护装置，易出现肺栓塞
流体动力式血栓切除设备	AngioJet系统	高速流动的流体溶栓，产生负压吸栓	治疗效率高，且不会对静脉壁及瓣膜造成严重的损坏	氯化钠溶液高压喷射可能会引起溶血，潜在肾功能损伤，不能充分治疗壁黏附和有组织的血栓
流体动力式血栓切除设备	Oasis系统	高速流动的流体溶栓，产生负压吸栓	治疗效率高，且不会对静脉壁及瓣膜造成严重的损坏	氯化钠溶液高压喷射可能会引起溶血，潜在肾功能损伤，不能充分治疗壁黏附和有组织的血栓
超声消融式设备	EKOS系统	EKOS导丝传到超声溶栓	溶血少，内皮损伤小，可使血栓粉碎成较小的微粒，减少肺栓塞的发生	溶栓效果较差，所需时间较长
超声消融式设备	Acolysis系统	高频超声能量使导管末端的小金属尖端振动溶栓	溶血少，内皮损伤小，可使血栓粉碎成较小的微粒，减少肺栓塞的发生	溶栓效果较差，所需时间较长

分类	设备	原理	特点	局限性
旋转涡轮式血栓消融器	Amplatz系统	叶轮旋转、粉碎血栓	操作简便，手术时间短	无导丝引导，粉碎血细胞和血栓物质再次进入循环，易出现肺栓塞、血管损伤、溶血
	Trellis系统	球囊阻断，震动导丝溶栓	隔离血栓，避免远端栓塞	易损伤血管壁
	Cleaner系统	柔性S形导丝破碎血栓	柔性导丝减少血管壁损伤	二者通过导丝将血栓破坏，无远端保护装置，易出现肺栓塞
	Aspirex系统	旋转式线控装置溶栓	头部本身不旋转，减少损伤血管风险	二者通过导丝将血栓破坏，无远端保护装置，易出现肺栓塞
流体动力式血栓切除设备	AngioJet系统	高速流动的流体溶栓，产生负压吸栓	治疗效率高，且不会对静脉壁及瓣膜造成严重的损坏	氯化钠溶液高压喷射可能会引起溶血，潜在肾功能损伤，不能充分治疗壁黏附和有组织的血栓
流体动力式血栓切除设备	Oasis系统	高速流动的流体溶栓，产生负压吸栓	治疗效率高，且不会对静脉壁及瓣膜造成严重的损坏	氯化钠溶液高压喷射可能会引起溶血，潜在肾功能损伤，不能充分治疗壁黏附和有组织的血栓
超声消融式设备	EKOS系统	EKOS导丝传到超声溶栓	溶血少，内皮损伤小，可使血栓粉碎成较小的微粒，减少肺栓塞的发生	溶栓效果较差，所需时间较长
超声消融式设备	Acolysis系统	高频超声能量使导管末端的小金属尖端振动溶栓	溶血少，内皮损伤小，可使血栓粉碎成较小的微粒，减少肺栓塞的发生	溶栓效果较差，所需时间较长

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