Comparison of therapeutic effects between AcoStream and AngioJet in acute iliofemoral vein thrombosis

doi:10.11958/20240740

Abstract

Abstract:

Objective To investigate the clinical efficacy and safety of two thrombus thrombectomy devices, AcoStream and AngioJet, in the treatment of acute iliofemoral vein thrombosis (AIFVT).Methods A total of 97 AIFVT patients were treated with different thrombus clearing devices according to their states of illness, and patients were divided into the AcoStream group (41 cases) and the AngioJet group (56 cases). The thrombus clearing status, degree of swelling reduction in affected limb, surgical time and intraoperative blood loss were compared between the two groups, and the need for assisted catheter contact thrombolysis (CDT) treatment, urokinase dosage, iliac vein stent placement, incidence of complications, length of hospital stay and hospitalization costs were also compared between the two groups. Regular follow-up was conducted to record for recurrence of thrombosis, the patency of the stent, deep vein thrombosis syndrome (PTS) and PTS degree were evaluated in lower limbs.Results There were no significant differences in age, gender, affected limb, time of illness, site of illness and causes of illness between the two groups (P>0.05). The operation was successful in both groups and the thrombus removal effect was satisfactory. There were no significant differences in terms of thrombus clearance rate, the degree of swelling reduction in the limb 48 hours after surgery and assisted CDT rate between the two groups (P>0.05). Compared with the AcoStream group, the AngioJet group had a longer surgical time, reduced intraoperative blood loss, increased hospitalization costs and higher rates of complications (P<0.05). There was no significant difference in the recurrence rate of thrombosis between the two groups (P>0.05), and there was no occurrence of iliac vein stent occlusion or PTS in either patients.Conclusion Two mechanical thrombus clearing devices of AcoStream and AngioJet are safe and effective for treating AIFVT.

Key words: thrombosis, iliofemoral vein, mechanical thrombus clearance, AcoStream, AngioJet

CLC Number:

R654.4

Figures/Tables 4

References 20

[1]	NI Q, LONG J, GUO X, et al. Clinical efficacy of one-stage thrombus removal via contralateral femoral and ipsilateral tibial venous access for pharmacomechanical thrombectomy in entire-limb acute deep vein thrombosis[J]. J Vasc Surg Venous Lymphat Disord, 2021, 9(5):1128-1135. doi:10.1016/j.jvsv.2021.01.007.
[2]	黄晓燕, 许媛媛, 周帅, 等. 上海市级医院静脉血栓栓塞症信息监测平台建设实践[J]. 中国卫生质量管理, 2024, 31(6):5-8.
	HUANG X Y, XU Y Y, ZHOU S, et al. Construction of information monitoring platform for venous thrombosisembolism in Shanghai municipal hospitals[J]. Chinese Health Quality Management, 2024, 31(6):5-8. doi:10.13912/j.cnki.chqm.2024.31.6.02.
[3]	VEDANTHAM S, SALTER A, LANCIA S, et al. Clinical outcomes of a pharmacomechanical catheter-directed venous thrombolysis strategy that included rheolytic thrombectomy in a multicenter randomized trial[J]. J Vasc Interv Radiol, 2021, 32(9):1296-1309.e7. doi:10.1016/j.jvir.2021.06.001.
[4]	COMEROTA A J, GREWAL N, MARTINEZ J T, et al. Post thrombotic Morbidity correlates with residual thrombus following catheter-directed thrombolysis for iliofemoral deep vein thrombosis[J]. J Vasc Surg, 2012, 55(3):768-773. doi:10.1016/j.jvs.2012.02.053.
[5]	XU Y J, WANG X M, SHANG D, et al. Out come of Angiojet mechanical thrombus aspiration in the treatment of acute lower extremities deep venous thrombosis[J]. Vacular, 2021, 29(3):415-423. doi:10.1177/1708538120958595.
[6]	张训, 陈红燕. AcoStream血栓抽吸装置在急性下肢深静脉血栓中的运用体会[J]. 生命科学仪器, 2024, 22(1):186-188.
	ZHANG X, CHEN H Y. Application of AcoStream thrombus aspiration device in the treatment of acute lower extremity deep vein thrombosis[J]. Life Science Instruments, 2024, 22(1):186-188. doi:10.11967/2024220261.
[7]	陈保星, 李会朋, 郭鹏威, 等. AngioJet和AcoStream血栓清除装置在亚急性期下肢深静脉血栓治疗中效果[J]. 中华实用诊断与治疗杂志, 2024, 38(6):584-588.
	CHEN B X, LI H P, GUO P W, et al. Efficacies of AngioJet and AcoStream on subacute lower limb deep vein thrombosis[J]. J Chin Pract Diagn Ther, 2024, 38(6):584-588. doi:10.13507/ j.issn.1674-3474.2024.06.009.
[8]	林越, 陈刚, 洪翔, 等. 8F Zelante和6F Solent血栓去除导管治疗下肢深静脉血栓形成的疗效对比分析[J]. 中华血管外科杂志, 2023, 8(2):205-209.
	LIN Y, CHEN G, HONG X, et al. Comparative analysis of the therapeutic effects of 8F Zelante and 6F Solent thrombectomy catheters in the treatment of deep vein thrombosis in the lower limbs[J]. J Chin Vasc Surg, 2023, 8(2):205-209. doi:10.3760/cma.j.cn101411-20230414-00036.
[9]	NOTTEN P, TEN CATE-HOEK A J, ARNOLDUSSEN C, et al. Ultrasound-accelerated catheter-directed thrombolysis versus anticoagulation for the prevention of post-thrombotic syndrome (CAVA):a single-blind,multicentre,randomised trial[J]. Lancet Haematol, 2020, 7(1):e40-e49. doi:10.1016/ S2352- 3026(19)30209-1.
[10]	中国医师协会介入医师分会, 中华医学会放射学分会介入专业委员会, 中国静脉介入联盟. 下肢深静脉血栓形成介人治疗规范的专家共识(第2版)[J]. 介入放射学杂志, 2019, 28(1):1-10.
	Interventional Physicians Branch of the Chinese Medical Association,Interventional Professional Committee of the Radiology Branch of the Chinese Medical Association, Chinese Venous Interventional Alliance. Expert consensus on interventional treatment standards for lower limb deep venous thrombosis (2nd edition)[J]. J Intervent Radiol, 2019, 28 (1):1-10. doi:10.3969/j.Issn.1008-794X.2019.01.001.
[11]	李春亭, 胡可, 王维慈, 等. AngioJet血栓抽吸术与置管溶栓术治疗下肢静脉血栓形成后综合征的临床疗效[J]. 血管与腔内血管外科杂志, 2021, 7(2):145-149.
	LI C T, HU K, WANG W C, et al. Clinical efficacy of AngioJet thrombus aspiration and catheter-directed thrombolysis in the treatment of lower extremity post-thrombotic syndrome[J]. J Vasc and Endo Surg, 2021, 7(2):145-149. doi:10.19418/j.cnki.issn2096-0646.2021.02.05.
[12]	KAHN S R. Measurement properties of the Villalta scale to define and classify the severity of the post-thrombotic syndrome[J]. J Thromb Haemost, 2009, 7(5):884-888. doi:10.1111/j.1538-7836.2009.03339.x.
[13]	徐淼, 张喜成, 陈兆雷, 等. 大腔导管手动抽吸和经皮机械血栓清除术治疗髂静脉闭塞继发髂股静脉血栓形成的比较[J]. 中国普通外科杂志, 2021, 30(6):663-669.
	XU M, ZHANG X C, CHEN Z L, et al. Comparison of manual aspiration with large lumen catheter and percutaneous mechanical thrombectomy for the treatment of secondary iliofemoral vein thrombosis caused by iliac vein occlusion[J]. Chinese Journal of General Surgery, 2021, 30(6):663-669. doi:10.7659/j.issn.1005-6947.2021.06.005.
[14]	DOPHEIDE J F, SEBASTIAN T, ENGELBERGER R P, et al. Early clinical outcomes of a novel rheolytic directional thrombectomy technique for patients with iliofemoral deep vein thrombosis[J]. Vasa, 2018, 47(1):56-62. doi:10.1024/0301-1526/a000666.
[15]	KAKKOS S K, GOHEL M, BAEKGAARD N, et al. Editor's choice-European society for vascular surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis[J]. Eur J Vasc Endovasc Surg, 2021,61(1):9-82. doi:10.1111/j.1538-7836.2009.03339.x.
[16]	王家兴, 任建庄, 韩新巍, 等. Angiojet机械血栓清除在急性肠系膜上动脉栓塞治疗中的应用价值[J]. 介入放射学杂志, 2021, 30(9):920-924.
	WANG J X, REN J Z, HAN X W, et al. The application value of Angiojet mechanical thrombectomy in the treatment of acute superior mesenteric artery embolism[J]. J Intervent Radiol, 2021, 30(9):920-924. doi:10.3969/j.issn.1008-794X.2021.09.013.
[17]	GONG M, FU G, LIU Z, et al. Rheolytic thrombectomy using an AngioJet Zelante DVT catheter or a Solent Omni catheter for patients with proximal vein thrombosis[J]. Thromb J, 2023, 21(1):25. doi:10.1186/s12959-023-00472-9.
[18]	曾金福, 黄永豪, 黄伟, 等. AcoStream血栓抽吸装置用于下肢深静脉血栓治疗的疗效以及安全性分析[J]. 临床普外科电子杂志, 2023, 11(3):61-64.
	ZENG J F, HUANG Y H, HUANG W, et al. The efficacy and safety analysis of AcoStream thrombus suction device for the treatment of deep vein thrombosis in the lower limbs[J]. Journal of General Surgery for Clinicians, 2023, 11(3):61-64. doi:10.9935/j.Issn.1009-793X.2023.11.003.
[19]	袁园, 黄昊, 顾建平, 等. Acostream血栓抽吸装置治疗急性下肢缺血6例[J]. 介入放射学杂志, 2022, 31(12):1151-1154.
	YUAN Y, HUANG H, GU J P, et al. Acostream thrombus aspiration device for the treatment of 6 cases of acute lower limb ischemia[J]. J Intervent Radiol, 2022, 31(12):1151-1154. doi:10.3969/j.Issn.1008-794X.2022.12.003.
[20]	MIROSLAV B. Mechanical atherothrombectomy in the treatment of peripheral arterial in-stent occlusions[J]. Vascular, 2020, 28(2):152-158. doi:10.1177/1708538119890961.

组别	股青肿			血栓范围（A/B/C）		发病诱因（A/B/C/D/E）
组别		n	性别（男/女）		年龄/ 岁		患肢（左/右）	发病时间/d
AcoStream组		41	18/23		56.4±11.6		33/8	5.5±2.3
AngioJe组		56	24/32		53.2±10.9		46/10	4.6±2.9
χ²或t			0.998		0.123		0.252	0.06
AcoStream组	1（2.4）			13/15/13		11/6/9/3/12
AngioJe组	2（3.6）			15/20/21		15/8/13/4/16
χ²	0.104			0.430		0.373

组别	股青肿			血栓范围（A/B/C）		发病诱因（A/B/C/D/E）
组别		n	性别（男/女）		年龄/ 岁		患肢（左/右）	发病时间/d
AcoStream组		41	18/23		56.4±11.6		33/8	5.5±2.3
AngioJe组		56	24/32		53.2±10.9		46/10	4.6±2.9
χ²或t			0.998		0.123		0.252	0.06
AcoStream组	1（2.4）			13/15/13		11/6/9/3/12
AngioJe组	2（3.6）			15/20/21		15/8/13/4/16
χ²	0.104			0.430		0.373

组别	n	血栓清除率（Ⅲ/Ⅱ/Ⅰ）		手术时间/ min	患肢消肿程度/cm		辅助CDT		失血量/mL
AcoStream组	41	30/10/1		63.6±15.4	3.0±0.8		11（26.8）		255.5±67.5
AngioJet组	56	42/13/1		90.7±17.2	3.1±0.8		18（32.2）		137.9±73.1
t或χ²		0.073		5.945^＊	1.990		0.693		9.219^＊
组别		尿激酶总用量/万U	支架置入率			住院时间/d		住院费用/元
AcoStream组		30.5±18.5	22（53.7）			5.8±1.7		32 476.2±3 319.8
AngioJet组		57.5±14.5	33（58.9）			5.3±1.4		56 791.6±5 116.3
t或χ²		17.572^＊	0.268			0.454		10.274^＊

组别	n	血栓清除率（Ⅲ/Ⅱ/Ⅰ）		手术时间/ min	患肢消肿程度/cm		辅助CDT		失血量/mL
AcoStream组	41	30/10/1		63.6±15.4	3.0±0.8		11（26.8）		255.5±67.5
AngioJet组	56	42/13/1		90.7±17.2	3.1±0.8		18（32.2）		137.9±73.1
t或χ²		0.073		5.945^＊	1.990		0.693		9.219^＊
组别		尿激酶总用量/万U	支架置入率			住院时间/d		住院费用/元
AcoStream组		30.5±18.5	22（53.7）			5.8±1.7		32 476.2±3 319.8
AngioJet组		57.5±14.5	33（58.9）			5.3±1.4		56 791.6±5 116.3
t或χ²		17.572^＊	0.268			0.454		10.274^＊