Meta-analysis of the early and mid-term efficacy of AngioJet mechanical thrombectomy andcatheter-directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TAN Qiang , CHEN Hang , CHEN Jingquan , ZHENG Guoxue ,  ZHENG Jianghua

Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

ZHENG Jianghua, Email: zhengjianghua@126.com

Keywords：

acute lower extremity deep venous thrombosis; AngioJet mechanical thrombectomy; catheter-directed thrombolysis; meta-analysis

DOI：

10.7507/1007-9424.202008073

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Objective To systematically evaluated the efficacy of AngioJet mechanical thrombectomy and catheter-directed thrombolysis (CDT) in the treatment of acute lower extremity deep venous thrombosis (LEDVT).Methods According to the retrieval strategy of Cochrane collaboration network, the relevant literatures in CNKI, WangFang, VIP, CBM, PubMed, Embase, Cochrane Library, Web of Science at home and abroad up to March 25, 2020 were collected, and the meta analysis was performed by using Review Manager 5.3 software.Results A total of 20 observational studies were included in the meta analysis. The total number of patients was 1 566, which 799 cases in the AngioJet group and 767 cases in the CDT group. The results showed that the AngioJet group had a higher patency rate of deep vein ［MD=11.34, 95%CI (6.16, 16.51), P<0.000 1］, lower or shorter Villalta score ［MD=–1.90, 95%CI (–2.71, –1.10), P<0.000 01］, incidence of post-thrombotic syndrome［PTS, OR=0.42, 95%CI (0.23, 0.77), P=0.005］, rate of clot reduction grade Ⅰ events ［OR=0.40, 95%CI (0.24, 0.67), P=0.000 5］, incidence of bleeding complication ［OR=0.32, 95%CI (0.21, 0.49), P<0.000 01］, and hospital stay ［MD=–2.96, 95%CI (–3.69, –2.22), P<0.000 01］.Conclusions In the early efficacy, AngioJet mechanical thrombectomy has better patency rate of deep vein and thrombolysis, shorter hospital stay, and lower risk of bleeding than CDT. In the mid-term effect, AngioJet mechanical thrombectomy could reduce the incidence and the severity of PTS.

Citation： TAN Qiang, CHEN Hang, CHEN Jingquan, ZHENG Guoxue, ZHENG Jianghua. Meta-analysis of the early and mid-term efficacy of AngioJet mechanical thrombectomy andcatheter-directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(5): 610-618. doi: 10.7507/1007-9424.202008073 Copy

1.	Law Y, Chan YC, Cheng SWK. Epidemiological updates of venous thromboembolism in a Chinese population. Asian J Surg, 2018, 41(2): 176-182.
2.	Kearon C. Natural history of venous thromboembolism. Circulation, 2003, 107(23 Suppl 1): I22-I30.
3.	Bond RT, Cohen JM, Comerota A, et al. Surgical treatment of moderate-to-severe post-thrombotic syndrome. Ann Vasc Surg, 2013, 27(2): 242-258.
4.	Diniz J, Coelho A, Mansilha A. Endovascular treatment of iliofemoral deep venous thrombosis: is there enough evidence to support it? A systematic review with meta-analysis. Int Angiol, 2020, 39(2): 93-104.
5.	Huang CY, Hsu HL, Kuo TT, et al. Percutaneous pharmacomechanical thrombectomy offers lower risk of post-thrombotic syndrome than catheter-directed thrombolysis in patients with acute deep vein thrombosis of the lower limb. Ann Vasc Surg, 2015, 29(5): 995-1002.
6.	Kim HS, Patra A, Paxton BE, et al. Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis: clinical and economic outcomes. J Vasc Interv Radiol, 2006, 17(7): 1099-1104.
7.	Kuo TT, Huang CY, Hsu CP, et al. Catheter-directed thrombolysis and pharmacomechanical thrombectomy improve midterm outcome in acute iliofemoral deep vein thrombosis. J Chin Med Assoc, 2017, 80(2): 72-79.
8.	Lin PH, Zhou W, Dardik A, et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg, 2006, 192(6): 782-788.
9.	Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg, 1995, 21(4): 635-645.
10.	Wik HS, Ghanima W, Sandset PM, et al. Scoring systems for postthrombotic syndrome. Semin Thromb Hemost, 2017, 43(5): 500-504.
11.	Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10(3): D142.
12.	Zou JB, Zhang XF, Wang J, et al. The therapeutic efficacy of danhong injection combined with percutaneous coronary intervention in acute coronary syndrome: a systematic review and meta-analysis. Front Pharmacol, 2018, 9: 550.
13.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
14.	Tang T, Chen L, Chen J, et al. Pharmacomechanical thrombectomy versus catheter-directed thrombolysis for iliofemoral deep vein thrombosis: a meta-analysis of clinical trials. Clin Appl Thromb Hemost, 2019, 25: 1076029618821190.
15.	任伟强, 徐树彬, 曹莉明, 等. 机械血栓清除治疗下肢深静脉血栓临床效果观察. 临床误诊误治, 2019, 32(11): 54-59.
16.	尹孝亮, 郎德海, 王迪. 经皮机械血栓清除治疗急性髂股静脉血栓形成患者疗效观察. 浙江大学学报(医学版), 2018, 47(6): 588-594.
17.	赵亲明, 许中友. Angiojet机械吸栓与置管溶栓在急性髂股静脉血栓治疗中的疗效对比. 现代实用医学, 2019, 31(5): 617-619.
18.	刘磊, 冯家煊, 王宏飞, 等. 下肢深静脉血栓形成的AngioJet机械吸栓与置管溶栓的对比研究. 中华血管外科杂志, 2016, 1(1): 22-25.
19.	宋进华, 何旭, 楼文胜, 等. AngioJet血栓抽吸装置治疗急性髂股静脉血栓形成. 中华普通外科杂志, 2018, 33(2): 109-113.
20.	赵宇, 朱兆红, 秦金保, 等. 导管接触溶栓与机械辅助吸栓治疗急性髂股静脉血栓的对比研究. 现代生物医学进展, 2017, 17(18): 3486-3489.
21.	Yin SW, Guo LW, Bian L, et al. Evaluation of percutaneous mechanical thrombectomy via the angiojet system combined with catheter-directed thrombolysis for the treatment of symptomatic lower extremity deep venous thrombosis. Ann Vasc Surg, 2020, 65: 66-71.
22.	Zhu J, Ni CF, Dai ZY, et al. A case-controlled study on AngioJet rheolytic thrombectomy and catheter-directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis. Vascular, 2020, 28(2): 177-182.
23.	高锋利, 王克华, 苟伟, 等. 经皮腔内机械药物血栓清除术与导管接触溶栓治疗急性深静脉血栓形成的早期对照研究. 宁夏医学杂志, 2019, 41(9): 804-806.
24.	韩松. 单纯置管溶栓与机械性血栓清除治疗下肢深静脉血栓的疗效评价. 苏州大学, 2018.
25.	韩新强. 流变力学血栓清除系统在下肢深静脉血栓治疗中的应用研究及相关问题探讨. 济南: 山东大学, 2017.
26.	黄宝骏, 杨澄宇, 骆曦图, 等. Angiojet机械吸栓联合接触性溶栓治疗下肢深静脉血栓的近期疗效. 广东医学, 2019, 40(3): 366-369.
27.	李克伟. 药物机械偶联式血栓清除术治疗急性下肢深静脉血栓形成的临床研究. 苏州: 苏州大学, 2016.
28.	李明泽, 梁黎, 宋威, 等. 经颈静脉AngioJet消融联合置管溶栓治疗左下肢深静脉血栓. 实用放射学杂志, 2019, 35(12): 1996-2001.
29.	毛茅, 李春孟. AngioJet血栓抽吸系统治疗下肢深静脉血栓的效果观察. 浙江医学, 2018, 40(24): 2698-2700.
30.	严金. AngioJet机械血栓清除术与置管溶栓治疗急性下肢深静脉血栓形成的临床对比研究. 浙江大学, 2018.
31.	赵健, 谷岩, 张晶, 等. AngioJet机械血栓清除治疗急性下肢深静脉血栓形成. 中国中西医结合外科杂志, 2018, 24(6): 776-779.
32.	Prandoni P, Lensing AW, Prins MH, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med, 2004, 141(4): 249-256.
33.	Du GC, Zhang MC, Zhao JC. Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis. Vasa, 2015, 44(3): 195-202.
34.	Garcia MJ, Lookstein R, Malhotra R, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: Final report of the Prospective Multicenter PEARL (Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths) Registry. J Vasc Interv Radiol, 2015, 26(6): 777-785.

1. Law Y, Chan YC, Cheng SWK. Epidemiological updates of venous thromboembolism in a Chinese population. Asian J Surg, 2018, 41(2): 176-182.
2. Kearon C. Natural history of venous thromboembolism. Circulation, 2003, 107(23 Suppl 1): I22-I30.
3. Bond RT, Cohen JM, Comerota A, et al. Surgical treatment of moderate-to-severe post-thrombotic syndrome. Ann Vasc Surg, 2013, 27(2): 242-258.
4. Diniz J, Coelho A, Mansilha A. Endovascular treatment of iliofemoral deep venous thrombosis: is there enough evidence to support it? A systematic review with meta-analysis. Int Angiol, 2020, 39(2): 93-104.
5. Huang CY, Hsu HL, Kuo TT, et al. Percutaneous pharmacomechanical thrombectomy offers lower risk of post-thrombotic syndrome than catheter-directed thrombolysis in patients with acute deep vein thrombosis of the lower limb. Ann Vasc Surg, 2015, 29(5): 995-1002.
6. Kim HS, Patra A, Paxton BE, et al. Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis: clinical and economic outcomes. J Vasc Interv Radiol, 2006, 17(7): 1099-1104.
7. Kuo TT, Huang CY, Hsu CP, et al. Catheter-directed thrombolysis and pharmacomechanical thrombectomy improve midterm outcome in acute iliofemoral deep vein thrombosis. J Chin Med Assoc, 2017, 80(2): 72-79.
8. Lin PH, Zhou W, Dardik A, et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg, 2006, 192(6): 782-788.
9. Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg, 1995, 21(4): 635-645.
10. Wik HS, Ghanima W, Sandset PM, et al. Scoring systems for postthrombotic syndrome. Semin Thromb Hemost, 2017, 43(5): 500-504.
11. Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10(3): D142.
12. Zou JB, Zhang XF, Wang J, et al. The therapeutic efficacy of danhong injection combined with percutaneous coronary intervention in acute coronary syndrome: a systematic review and meta-analysis. Front Pharmacol, 2018, 9: 550.
13. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
14. Tang T, Chen L, Chen J, et al. Pharmacomechanical thrombectomy versus catheter-directed thrombolysis for iliofemoral deep vein thrombosis: a meta-analysis of clinical trials. Clin Appl Thromb Hemost, 2019, 25: 1076029618821190.
15. 任伟强, 徐树彬, 曹莉明, 等. 机械血栓清除治疗下肢深静脉血栓临床效果观察. 临床误诊误治, 2019, 32(11): 54-59.
16. 尹孝亮, 郎德海, 王迪. 经皮机械血栓清除治疗急性髂股静脉血栓形成患者疗效观察. 浙江大学学报(医学版), 2018, 47(6): 588-594.
17. 赵亲明, 许中友. Angiojet机械吸栓与置管溶栓在急性髂股静脉血栓治疗中的疗效对比. 现代实用医学, 2019, 31(5): 617-619.
18. 刘磊, 冯家煊, 王宏飞, 等. 下肢深静脉血栓形成的AngioJet机械吸栓与置管溶栓的对比研究. 中华血管外科杂志, 2016, 1(1): 22-25.
19. 宋进华, 何旭, 楼文胜, 等. AngioJet血栓抽吸装置治疗急性髂股静脉血栓形成. 中华普通外科杂志, 2018, 33(2): 109-113.
20. 赵宇, 朱兆红, 秦金保, 等. 导管接触溶栓与机械辅助吸栓治疗急性髂股静脉血栓的对比研究. 现代生物医学进展, 2017, 17(18): 3486-3489.
21. Yin SW, Guo LW, Bian L, et al. Evaluation of percutaneous mechanical thrombectomy via the angiojet system combined with catheter-directed thrombolysis for the treatment of symptomatic lower extremity deep venous thrombosis. Ann Vasc Surg, 2020, 65: 66-71.
22. Zhu J, Ni CF, Dai ZY, et al. A case-controlled study on AngioJet rheolytic thrombectomy and catheter-directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis. Vascular, 2020, 28(2): 177-182.
23. 高锋利, 王克华, 苟伟, 等. 经皮腔内机械药物血栓清除术与导管接触溶栓治疗急性深静脉血栓形成的早期对照研究. 宁夏医学杂志, 2019, 41(9): 804-806.
24. 韩松. 单纯置管溶栓与机械性血栓清除治疗下肢深静脉血栓的疗效评价. 苏州大学, 2018.
25. 韩新强. 流变力学血栓清除系统在下肢深静脉血栓治疗中的应用研究及相关问题探讨. 济南: 山东大学, 2017.
26. 黄宝骏, 杨澄宇, 骆曦图, 等. Angiojet机械吸栓联合接触性溶栓治疗下肢深静脉血栓的近期疗效. 广东医学, 2019, 40(3): 366-369.
27. 李克伟. 药物机械偶联式血栓清除术治疗急性下肢深静脉血栓形成的临床研究. 苏州: 苏州大学, 2016.
28. 李明泽, 梁黎, 宋威, 等. 经颈静脉AngioJet消融联合置管溶栓治疗左下肢深静脉血栓. 实用放射学杂志, 2019, 35(12): 1996-2001.
29. 毛茅, 李春孟. AngioJet血栓抽吸系统治疗下肢深静脉血栓的效果观察. 浙江医学, 2018, 40(24): 2698-2700.
30. 严金. AngioJet机械血栓清除术与置管溶栓治疗急性下肢深静脉血栓形成的临床对比研究. 浙江大学, 2018.
31. 赵健, 谷岩, 张晶, 等. AngioJet机械血栓清除治疗急性下肢深静脉血栓形成. 中国中西医结合外科杂志, 2018, 24(6): 776-779.
32. Prandoni P, Lensing AW, Prins MH, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med, 2004, 141(4): 249-256.
33. Du GC, Zhang MC, Zhao JC. Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis. Vasa, 2015, 44(3): 195-202.
34. Garcia MJ, Lookstein R, Malhotra R, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: Final report of the Prospective Multicenter PEARL (Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths) Registry. J Vasc Interv Radiol, 2015, 26(6): 777-785.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Meta-analysis of the early and mid-term efficacy of AngioJet mechanical thrombectomy andcatheter-directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis

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