Surgical Thrombectomy for Acute Deep Venous Thrombosis of Lower Extremities: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 LUO Xiaoyun , WU Qinghua , KOU Lei

Department of Vascular Surgery, Anzhen Hospital of Capital University of Medical Sciences, Beijing 100029, China;

Corresponding author：

LUO Xiaoyun, Email: paperworld@vip.163.com

Keywords：

Deep venous thrombosis; Lower extremity; Thrombectomy; Systematic review; Randomized controlled trial

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Objective 　To evaluate the effectiveness and safety of surgical thrombectomy for acute deep venous thrombosis of lower extremities.
Methods 　Randomized controlled trials of surgery versus conservative treatment were sought from MEDLINE (1966-Jun.2006), EMbase (1974-Jun.2006), The Cochrane Library (Issue 2, 2006), CBM (1989-Jun. 2006) and CMCC (1994-Jun. 2006). Collections of Chinese Congress on Vascular Surgery (1991-Jun.2006) and the journal of Vascular Surgery (2000-Jun. 2006) were handsearched. Two reviewers independently extracted data into a designed extraction form. The guidance in The Cochrane Collaboration’s Handbook was consulted for quality evaluation and data analysis.
Results 　Six potentially eligible studies were identified. Six were included according to the inclusion criteria. The 6-month total patency was significantly higher in the surgical treatment group than in the conservative treatment group with OR 7.26 and 95%CI 2.40 to 21.94, while the 5-year total patency was not different between the two groups with OR 2.59 and 95%CI 0.88 to 7.67. At month 6 and year 5, the incidence of post-thrombosis syndrome (PTS) was significantly higher in the conservative treatment group than in the surgical treatment group with OR 0.11, 95%CI 0.59 to 1.59, OR0.18, 95%CI 0.06 to 0.60 respectively. The incidence of 10-year PTS and the results of valvular function measurements were similar between the two groups. The incidence of pulmonary thrombosis was also comparable between the two groups with OR 1.40 and 95%CI 0.39 to 4.97.
Conclusion 　Surgical thrombectomy may improve the extent of patency and venous valvular sufficiency in the short term, but without increasing the patency rate. There is no enough evidence to assess whether surgical throbectomy improves long-term outcomes. It is safe to preform surgical thrombectomy. The small number of patients randomised and the low quality of the trials decreases the reliability of the current evidence. Therefore, more high quality randomised controlled studies should be done, to determine the long-term outcomes of surgical thrombectomy.

Citation： LUO Xiaoyun,WU Qinghua,KOU Lei. Surgical Thrombectomy for Acute Deep Venous Thrombosis of Lower Extremities: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2006, 06(11): 815-819. doi: Copy

1.	董国祥. 急性下肢深静脉血栓形成的手术治疗. 中国实用外科杂志, 2003; 23(4): 210~211.
2.	黄晓钟, 王鹏, 张皓, 等. 下肢深静脉血栓形成165例的治疗分析. 中华普通外科杂志, 2002; 17(11): 666~667.
3.	何宇东, 周修静. 静脉血栓切除术对急性深静脉血栓形成的意义探讨. 现代临床普通外科. 1997: 2(3): 145~148.
4.	骆松辉, 龚时文, 闵军, 等. 早期急诊手术取栓治疗下肢深静脉血栓形成29例报告. 中国医师杂志, 2005; 7(10): 1363~1364.
5.	段鹏飞, 钱爱民, 桑宏飞, 等. 介入联合手术治疗急性下肢深静脉血栓形成. 解剖与临床, 2004; 9(2): 91~93.
6.	Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease. Chest, 2004; 126(3): 401S–418S.
7.	Juhan CM, Alimi YS, Barthelemy PJ, et al. Late results of iliofemoral venous thrombectomy. J Vasc Surg, 1997; 25(3): 417–422.
8.	Dong GX. Surgical treatment of acute deep venous thrombosis of lower extremities. Chinese Journal of Practical Surgery, 2003; 23(4): 210–211.
9.	Huang XZ, Wang P, Zhang H, et al. Treatment of lower extremity deep venous thrombosis in 165 patient. Chinese Journal of General Surgery, 2002; 17(11): 666–667.
10.	Plate G, Einarsson E, Ohlin P, et al. Thrombectomy with temporary arteriovenous fistula: the treatment of choice in acute iliofemoral venous thrombosis. J Vasc Surg, 1984; 1(6): 867–876.
11.	Plate G, Akesson H, Einarsson E, et al. Long-term results of venous thrombectomy combined with a temporary arterio-venous fistula. Eur J Vasc Surg, 1990; 4(5): 483–489.
12.	Plate G, Eklof B, Norgren L, et al. Venous thrombectomy for iliofemoral vein thrombosis--10-year results of a prospective randomised study. Eur J Vasc Endovasc Surg, 1997; 14(5): 367–374.
13.	Plate G, Ohlin P, Einarsson E, et al. Pulmonary embolism in acute iliofemoral venous thrombosis. Br J Surg, 1985; 72: 912–915.
14.	He YD, Zhou XJ. Significance of thrombectomy for acute deep venous thrombosis. Modern Clinics in General Surgery, 1997: 2(3): 145–148.
15.	Luo SH, Gong SW, MIN J, et al. Report on 29 cases of early thrombectomy for deep venous thrombosis of lower extremities. Journal of Chinese Physician, 2005; 107(10): 1363–1364.
16.	Blatter W, Heller G, Largiade G, et al. Combined regional thrombolysis and surgical thrombectomy for treatment of iliofemoral vein thrombosis. J Vasc Surg, 2004; 40: 620–625.
17.	Duan PF, Qian AM, Sang HF, et al. Intervention and surgical therapy of acute lower extremity deep vein thrombosis. Anatomy and Clinics, 2004; 9(2): 91–93.

1. 董国祥. 急性下肢深静脉血栓形成的手术治疗. 中国实用外科杂志, 2003; 23(4): 210~211.
2. 黄晓钟, 王鹏, 张皓, 等. 下肢深静脉血栓形成165例的治疗分析. 中华普通外科杂志, 2002; 17(11): 666~667.
3. 何宇东, 周修静. 静脉血栓切除术对急性深静脉血栓形成的意义探讨. 现代临床普通外科. 1997: 2(3): 145~148.
4. 骆松辉, 龚时文, 闵军, 等. 早期急诊手术取栓治疗下肢深静脉血栓形成29例报告. 中国医师杂志, 2005; 7(10): 1363~1364.
5. 段鹏飞, 钱爱民, 桑宏飞, 等. 介入联合手术治疗急性下肢深静脉血栓形成. 解剖与临床, 2004; 9(2): 91~93.
6. Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease. Chest, 2004; 126(3): 401S–418S.
7. Juhan CM, Alimi YS, Barthelemy PJ, et al. Late results of iliofemoral venous thrombectomy. J Vasc Surg, 1997; 25(3): 417–422.
8. Dong GX. Surgical treatment of acute deep venous thrombosis of lower extremities. Chinese Journal of Practical Surgery, 2003; 23(4): 210–211.
9. Huang XZ, Wang P, Zhang H, et al. Treatment of lower extremity deep venous thrombosis in 165 patient. Chinese Journal of General Surgery, 2002; 17(11): 666–667.
10. Plate G, Einarsson E, Ohlin P, et al. Thrombectomy with temporary arteriovenous fistula: the treatment of choice in acute iliofemoral venous thrombosis. J Vasc Surg, 1984; 1(6): 867–876.
11. Plate G, Akesson H, Einarsson E, et al. Long-term results of venous thrombectomy combined with a temporary arterio-venous fistula. Eur J Vasc Surg, 1990; 4(5): 483–489.
12. Plate G, Eklof B, Norgren L, et al. Venous thrombectomy for iliofemoral vein thrombosis--10-year results of a prospective randomised study. Eur J Vasc Endovasc Surg, 1997; 14(5): 367–374.
13. Plate G, Ohlin P, Einarsson E, et al. Pulmonary embolism in acute iliofemoral venous thrombosis. Br J Surg, 1985; 72: 912–915.
14. He YD, Zhou XJ. Significance of thrombectomy for acute deep venous thrombosis. Modern Clinics in General Surgery, 1997: 2(3): 145–148.
15. Luo SH, Gong SW, MIN J, et al. Report on 29 cases of early thrombectomy for deep venous thrombosis of lower extremities. Journal of Chinese Physician, 2005; 107(10): 1363–1364.
16. Blatter W, Heller G, Largiade G, et al. Combined regional thrombolysis and surgical thrombectomy for treatment of iliofemoral vein thrombosis. J Vasc Surg, 2004; 40: 620–625.
17. Duan PF, Qian AM, Sang HF, et al. Intervention and surgical therapy of acute lower extremity deep vein thrombosis. Anatomy and Clinics, 2004; 9(2): 91–93.

Chinese Journal of Evidence-Based Medicine

Surgical Thrombectomy for Acute Deep Venous Thrombosis of Lower Extremities: A Systematic Review

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