ObjectiveTo systematically evaluated the efficacy of AngioJet mechanical thrombectomy and catheter-directed thrombolysis (CDT) in the treatment of acute lower extremity deep venous thrombosis (LEDVT).MethodsAccording 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.ResultsA 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］.ConclusionsIn 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.
Objective To explore the therapeutic effect of catheter-directed thrombolysis combined with vena cava filter on deep venous thrombosis (DVT) of lower extremity.Methods The clinical data of 65 patients with DVT of lower extremities from January 2008 to August 2009 were analyzed retrospectively, whose course of diseases were not more than 7 d and clinical type included central type and mixed type. Thirty-two cases were treated with catheter-directed thrombolysis combined with vena cava filter, while administrating treatment of anticoagulation and activating blood circulation to dissipate blood stasis, which were named as study group. Thirty-three cases were treated traditionally with thrombolysis, anticoagulation, and activating blood circulation to dissipate blood stasis, which were named as control group. The course of therapy was continued 10-14 d, then the efficacy in two groups patients was evaluated. Results It was (7.35±1.42) cm that circumference difference before treatment between affected extremties and unaffected extremties in study group, which of 3, 7, and 14 d after treatment was (4.21±1.12) cm， (2.87±0.98) cm, and (1.22±1.02) cm, respectively. Circumference difference between before and after treatment had significant difference in study group (Plt;0.01). It was (6.97±1.27) cm that circumference difference before treatment between affected extremties and unaffected extremties in control group, which of 3, 7, and 14 d after treatment was (5.72±1.31) cm, (4.58±0.88) cm, and (3.18±1.24) cm, respectively. Circumference difference between before treatment and 3, 7, and 14 d after treatment had significant difference in control group (Plt;0.05 or Plt;0.01). Circumference difference before treatment in two groups had no significant difference (Pgt;0.05). Circumference difference after treatment at different time points in two groups was significantly different, respectively (Plt;0.01). Circumference difference after treatment at different time points in study group was significantly less than that in control group, respectively (Plt;0.01). After 14 d, complete recanalization rate （71.88%, 23/32） and cure rate (71.88%, 23/32) of iliofemoral vein in study group were significant higher than that (36.36%, 12/33) in control group (Plt;0.01). No pulmonary embolism occurred. Conclusion In terms of ideal therapy targets of DVT of lower extremity, the catheterdirected thrombolysis combined with vena cava filter is obviously superior to traditional thrombolysis treatment.
Objective To summarize the research about the stability of deep venous thrombosis (DVT) of the lower extremity in recent years. Methods The literatures about the stability of DVT of lower limbs at home and abroad in recent years were reviewed. Results There are few studies on the stability of DVT at home and abroad, which limited on the floating thrombus. Conclusion The stability of DVT can be effectively evaluated by SOMATOM Force CT (The third generation dual source CT).
ObjectiveTo observe the effect of anti-embolism stocking and air pressure therapeutic apparatus on the prevention of lower extremity deep vein thrombosis (DVT) after pelvic floor reconstruction. MethodsNinety-one patients who were treated with pelvic floor reconstruction between June 2011 and May 2013 were divided into trial group (n=42) and control group (n=49) according to random number table method. The patient age, body mass index (BMI), level of education, general anesthesia and surgery time between the two groups had no difference of statistical significance (P>0.05). The control group was treated traditionally. The trial group used anti-embolism stocking 30 minutes before surgery, and from 6 hours after operation until 3 days later when the patient could walk with the combined use of pneumatic therapeutic treatment. Between day 5 and 7 after surgery, lower limb vascular color Doppler ultrasound was done to observe the occurrence of lower limb DVT in both the two groups. ResultsThe incidence of lower extremity DVT was 2.38% and 18.36% in the trial and the control group respectively. There was a statistically significant difference between the two groups (P<0.05). ConclusionCombined use of anti-embolism stocking 30 minutes before operation and pneumatic therapeutic treatment 6 hours postoperatively can be effective in preventing the formation of DVT after total pelvic floor reconstruction.
Objective To study the significance of the levels of plasma inflammatory cytokines (IL-6，IL-8，IL-10 and TNF-α) in patients with acute deep venous thrombosis (DVT) of lower extremity. Methods Forty untreated DVT cases were selected as the subjects in the DVT group, while thirty healthy subjects, whose ages and genders showed no significant difference with the DVT patients, were collected as the control group. The plasma levels of IL-6, IL-8 and TNF-α were detected by radioimmunoassay (RIA), and the plasma level of IL-10 was measured by enzyme-linked immunosorbent assay (ELISA). Correlation analysis was used to investigate the relationships between the levels of different inflammatory cytokines within DVT group. Results The levels of plasma cytokines in the DVT group were all significantly higher than those in control group (P＜0.001). The results of the correlation analysis showed that there were positive correlations between IL-6 and TNF-α (r=0.383, P＜0.05), IL-10 and TNF-α (r=0.390, P＜0.05), respectively, within the DVT group; whereas there were no correlations between IL-6 and IL-8, IL-6 and IL-10, IL-8 and IL-10, and IL-8 and TNF-α. Conclusion The levels of plasma cytokines increased significantly in patients of DVT. Inflammatory cytokines may play an important role in acute DVT by accelerating the pace of thrombosis, intensifying the inflammatory reaction around thrombus and aggravating the injured blood vessel.
ObjectiveTo evaluate the value of clinical application of determination of lower venous pressure in the diagnosis and treatment of deep venous thrombosis (DVT). MethodsThe 90 patients with DVT of unilateral lower limb who were admitted by using color Doppler or deep veins of lower limb angiography in our hospital during the period of 2013 July to 2014 June were selected and as the research object (case group), 37 cases were male, 53 cases were female; the age was 18-84 years old, mean age was 59.48 years old. According to the development of disease, 90 cases were divided into acute 30 cases, subacute 30 cases, and chronic 30 cases; and according to the pathological types were divided into the central type in 30 cases, 30 cases of peripheral type, and 30 cases of mixed type. At the same time the without lower extremity DVT volunteers of 20 cases were selected as normal control group, including male 9 cases, female 11 cases; age was 21-65 years old, average age was 38.7 years old. The static venous pressure (P0), dynamic venous pressure (P00), and decreased pressure ratio (Pd) of double lower limbs of participants in 2 groups were determinated and comparative analyzed. ResultsThe P0 and P00 of patients with different development of disease and pathological types of the case group were higher than those of the normal control group (P < 0.01), and the Pd was lower than that of the normal control group (P < 0.01). In case group, the P0 and P00 of acute phase were higher than those of the normal control group (P < 0.01), the P0 of central type was higher than that of the peripheral type and mixed type (P < 0.01), and the Pd central type was lower than that of mixed type (P < 0.01). The above 3 indexes' differences of double lower limbs in the normal control group had no statistical significance (P > 0.01). In case group, the P0 and P00 of ipsilateral limb in different development of disease and pathological types were higher than those of the healthy limb, and the Pd were lower than that of the healthy limb (P < 0.01). ConclusionsLower extremity venous pressure measurements can be used in clinical detection for early lower limb DVT, and can be used as the objective index of clinical evaluation curative effect for the treatment of DVT. It is a simple and practical clinical detection method.
ObjectiveTo investigate the safety and effectiveness of using tranexamic acid in total knee arthroplasty (TKA). MethodsBetween May 2012 and May 2013, 88 patients (88 knees) with degenerative osteoarthritis underwent primary TKA and were divided into 2 groups (n=44) according to whether use of tranexamic acid (15 mg/kg) or not. Seventy-seven patients (39 in trial group and 38 in control group) were enrolled in this study except 11 patients who failed to be followed up. There was no significant difference in gender, age, disease duration, body mass index, osteoarthritis grading, and preoperative general data of laboratory examination between 2 groups (P > 0.05). The following indexes were recorded and compared between 2 groups: intraoperative tourniquet time, intraoperative blood loss, postoperative drainage volume during 24 hours, total drainage volume, hidden blood loss, total blood loss, the number of transfusion, postoperative haemoglobin (Hb) at 3 days, postoperative D-dimer at 24 hours, ecchymosis, and deep venous thrombosis (DVT). ResultsNo statistically significant difference was found in intraoperative tourniquet time and intraoperative blood loss between 2 groups (P > 0.05). The postoperative drainage volume during 24 hours, total drainage volume, hidden blood loss, total blood loss, and postoperative D-dimer at 24 hours in trial group were significantly lower than those in control group (P < 0.05). The postoperative Hb at 3 days in trial group was significantly higher than that in control group (t=4.815, P=0.000). Three cases (7.7%) of trial group and 4 cases (10.5%) of control group were given blood transfusion, showing no significant difference (P > 0.05); DVT occurred in 3 cases of 2 groups repectively (7.7%, 7.9%), showing no significant difference (P > 0.05). Extremity ecchymosis occurred in 1 case (2.6%) of trial group and in 7 cases (18.4%) of control group, showing significant difference (χ2=0.029, P=0.026). ConclusionUse of tranexamic acid can significantly reduce blood loss and does not increase the risk of DVT after TKA.
ObjectiveTo investigate the incidence of perioperative deep venous thrombosis (DVT) of lower extremities and its risk factors in elderly patients with femoral neck fracture. Methods The clinical data of 4 109 elderly patients with femoral neck fracture admitted between August 2012 and November 2020 and met the selection criteria were retrospectively analyzed. Among them, there were 1 137 males and 2 972 females; their ages ranged from 65 to 101 years, with an average of 77.0 years. The time from fracture to admission ranged from 1 to 360 hours, with an average of 35.2 hours. There were 1 858 cases of hemiarthroplasty, 1 617 cases of total hip arthroplasty, and 634 cases of internal fixation surgery. The preoperative age-adjusted Charlson comorbidity index (aCCI) was 4 (3, 5). Perioperative DVT occurred in 857 cases (20.9%). Univariate analysis was performed on age, gender, body mass index, fracture side, time from fracture to admission, operation type, anesthesia type, blood transfusion, blood pressure after admission, and preoperative aCCI in patients with and without perioperative DVT, and logistic regression analysis was used to screen the risk factors of perioperative DVT in elderly patients with femoral neck fracture. ResultsUnivariate analysis showed that there were significant differences in age, gender, time from fracture to admission, operation type, and preoperative aCCI between the two groups (P<0.05). Further logistic regression analysis showed that age>75 years, female patients, time from fracture to admission>24 hours, and preoperative aCCI>5 were risk factors for perioperative DVT (P<0.05). Conclusion Elderly patients with femoral neck fracture have a higher incidence of perioperative DVT. The advanced aged and female patients, patients with longer fracture time and more comorbidities need to pay special attention to the prevention of perioperative DVT to minimize the occurrence of DVT during femoral neck fractures.
Objective To study the effect of interleukin-6,10 (IL-6,10), C-reactive protein (CRP), and fibrinogen (FIB) on inflammatory response of lower limbs deep vein thrombosis (DVT). Methods Thirty patients with acute lower limb DVT (DVT group) and 30 volunteers (normal control group) were included in this study, and then the concentrations of serum IL-6, IL-10, CRP, and FIB were detected. Results The concentrations of serum IL-6, IL-10, CRP, and FIB of patients in DVT group before treatment were higher than those in normal control group (Plt;0.001). Compared with before treatment, the concentrations of serum IL-6, CRP, and FIB of patients after treatment were lower in DVT group (Plt;0.001), however, the concentration of serum IL-10 was higher (Plt;0.001). There was no difference of the concentrations of serum FIB between DVT group after treatment and normal control group (Pgt;0.05), but the concentrations of serum IL-6, IL-10, and CRP of patients in DVT group after treatment were higher than those in normal control group (Plt;0.05). Conclusion Inflammatory factors may involve in DVT. Therein IL-6, CRP, and FIB play important roles in acute stage of DVT, and IL-10 may have an anti-inflammatory effect.
ObjectiveTo compare vein valve function following pharmacomechanical thrombolysis (PMT) with simple catheter-directed thrombolysis (CDT) for deep vein thrombosis.MethodsWe retrospectively analyzed the clinical data of sixty patients who suffered acute lower extremity deep vein thrombsis in our hospital between October 2016 and March 2017. All patients underwent contralateral preprocedural duplex and bilateral postprocedure duplex to access patency and valve function. The patients were divided into three groups including a group A with catheter-directed thrombolysis (CDT) alone (36 patients with 20 males and 16 females at average age of 56 years), a group B with PMT alone (15 patients with 8 males and 7 females at average age of 55 years), and a group C with PMT combined CDT (9 patients with 4 males and 5 females at average age of 56 years). The valve function was compared among the Group A, Group B and Group C.ResultsThere were 40.0% (24/60) patients with bilateral femoral vein valve reflux, 40.0% (24/60) patients with unilateral femoral vein valve reflux (all in the treated limbs), 20% (12/60) patients had no reflux in both limbs. Of the limbs treated with CDT alone, PMT alone and PMT combined CDT, the rate of valve reflux was 38.9% (14/36), 33.3% (5/15), and 55.6% (5/9) respectively (P=0.077).ConclusionIn the patients suffering acute DVT, PMT or PMT combined CDT does not hamper valve function compared with CDT alone.