Objective To summarize the clinical outcome of combined operation for patients with Cockett syndrome complicated with acute symptomatic deep venous thrombosis （DVT）. Methods From October 2008 to March 2012， a total of 23 patients （male 8 cases and female 15 cases；mean age 59.3 years old， range 36-76 years old） with Cockett syndrome complicated with acute symptomatic DVT were underwent combined surgical venous thrombectomy and endovascular stenting in ipisilateral iliac vein in our hospital. All the patients were underwent duplex ultrasonography for diagnosis of DVT. The location of thrombosis in the left iliofemoral vein was 21 cases， right iliofemoral vein was 2 cases. The affected limb of all the patients were severely swell and pain. The mean time of symptomatic DVT occurring at operation was 2.53d. All the operations were performed under general anesthesia. The inferior vena cava filter was inserted before thrombectomy， iliac vein compression was diagnosed by angiography and treated with self-expandable stent after thrombectomy. Twenty-eight self-expandable stents were placed successfully. Results In all the cases， the procedural successful rate was 100%， the 30-day mortality rate was 0. One case suffered from hematoma at incision after operation. Median follow-up was 11.7 months （range 3-26 months）. There was no case of rethrombosis. Symptoms were disappeared in 21 cases， the leg slightly swelled in 2 patients. Conclusion Combined surgical thrombectomy and endovascular treatment for patients with Cockett syndrome complicated with acute symptomatic DVT is an effective and safe technique with low morbidity and good clinical results.
Objective To investigate the feasibility and efficacy of transcatheter directed thrombolysis （TDT） approach in treatment for deep venous thrombosis （DVT） of lower limbs and as compared with trans-dorsal pedis vein thrombolysis （TPVT） approach. Methods The clinical data of 437 patients with acute DVT （184 males and 253 females） at the age of （43±12） years （range 19-76 years） from July 2008 to January 2012 in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. Patients in the group TDT received TDT were 293 cases， 32 inferior vena cava filters were implanted. Patients in the group TPVT received TPVT were 65 cases， 4 inferior vena cava filters were implanted. Results The resolution time of thrombus in the group TDT was shorter than that in the group TPVT （6 d versus 9 d， P＜0.05）. The circumference difference of leg or upper leg before and after treatment in the TDT group was significantly greater than that in the TPVT group （P＜0.05）. The rate of venous patency was （65.2±15.4）% and preservation rate of valvular function was （78.2±12.6）% in the group TDT， and which was （63.8±16.3）% and （91.1±10.7）% in the group TPVT， respectively. The differences of venous patency rate was not statistically significant（P＞0.05） between two groups， but the prevervation rate of valvular function was significant difference （P＜0.05） .Hematomas in 3 cases and gross hematuria in 4 cases were observed， and displacement of inferior vena cava filter occurred in 1 patient in the group TDT. The gums bleed or gross hematuria in 5 cases were observed in the group TPVT. Conclusions Both TDT and TPVT can effectively relieve symptoms. TDT can shorten the course of disease， but itincreases functional damage of the deep vein valvular.
ObjectiveTo investigate the clinical efficacy of catheter directed thrombolysis (CDT) through three different approaches combined with iliac venous endovascular therapy for acute deep venous thrombosis (DVT) complicated with Cockett syndrome of the lower extremities. MethodThe clinical data of 87 patients with CDT through three different approaches (small saphenous vein group, popliteal vein group, and posterior tibial vein group) combined with iliac venous endovascular therapy for DVT complicated with Cockett syndrome of the lower extremities were analyzed retrospectively. ResultsThe lower extremity swelling of all the patients were disappeared obviously within 72 h after surgery, there was no death related surgery and pulmonary embolism. The limb edema reduction rates had no significant differences among the small saphenous vein group, popliteal vein group, and posterior tibial vein group﹝(77±13)% versus (82±12)% versus (77±18)%, P > 0.05﹞. The recanalization rates of thrombolysis had no significant differences among the above three groups﹝(86.5±10.6)% versus (92.0±7.7)% versus (87.3±7.8)%, P > 0.05﹞. The time required for the cannulation in the posterior tibial vein group was significantly shorter than that of the small saphenous vein group or popliteal vein group﹝(15.14±3.62) min versus (32.62±9.36) min or (42.79±13.30) min, P < 0.01﹞. All the patients were performed by balloon dilatation and iliac vein stenting. Eighty-seven cases were followed-up for 1-24 months, the primary patency rate of iliac venous was 100%. ConclusionsCDT with iliac venous endovascular therapy is an effective method in treatment of acute DVT with Cockett syndrome. CDT through posterior tibial vein is an easier and effective method with less complications and time. This way could be acceptable in basal hospital.
ObjectiveTo investigate the significance of catheter thrombolysis combined with one-stage iliac vein percutaneous transluminal angioplasty (or stent implantation) in the treatment of acute left lower extremity deep venous thrombosis secondary to Cockett syndrome.MethodsForty-one cases of Cockett syndrome complicated with acute left lower extremity deep vein thrombosis were retrospectively analyzed and summarized in our hospital from January 2016 to June 2019. Catheter directed thrombolysis was performed under the protection of filter, and percutaneous transluminal angioplasty or stent implantation was performed in the first stage of the iliac vein stenosis or occlusion after thrombolysis. Compared the circumference of upper and lower legs of 15 cm above and below patella of the healthy and affected limbs, before and after treatment, and analyzed the venous patency rate.ResultsThe average time of using thrombolytic catheter were (7±3) days, and the average dosage of urokinase was (358.32±69.38) ×104 U. A total of thirty-five Bard stents were implanted (35 cases), four cases underwent percutaneous transluminal angioplasty, and two cases gave up treatment. Before and after treatment, the circumference difference of the higher leg, the circumference difference of the lower leg, and the venous patency were significantly different before and after thrombolysis (P<0.01). The venous patency rate was 58%–75% in this group, and the average venous patency rate was (61±10)%. There was no severe bleeding complication occurred. Thirty-five patients were followed up for 3–26 months, the preservation rate of the valve was 82.86% (29/35), and the first patency rate of iliac vein was 100% (39/39). During the follow-up period, thrombosis recurred in one case of untreated iliac vein, and acute thrombosis in the right side of one case was caused by long iliac vein stent entering the inferior vena cava. No pulmonary embolism was found.ConclusionOn the basis of catheter thrombolysis, one stage removal of iliac vein obstruction in the treatment of acute left lower extremity deep venous thrombosis can relieve the clinical symptoms, reduce the recurrence rate of thrombosis, and reduce the occurrence of deep vein thrombosis syndrome after catheter thrombolysis.