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腸骨大腿部深部静脈血栓症の治療におけるAngioJet Pharmacomechanical Thrombectomyおよびカテーテル指示型血栓溶解療法とカテーテル指示型血栓溶解療法のみの比較。単一施設のレトロスペクティブコホート研究
AngioJet Pharmacomechanical Thrombectomy and Catheter Directed Thrombolysis vs. Catheter Directed Thrombolysis Alone for the Treatment of Iliofemoral Deep Vein Thrombosis: A Single Centre Retrospective Cohort Study.
PMID: 32665201 DOI: 10.1016/j.ejvs.2020.05.006.
抄録
目的:
腸大腿深部静脈血栓症（DVT）の治療には経皮的血栓除去術が用いられているが，異なる治療モダリティの有効性はまだ明らかにされていない。本研究の目的は、AngioJet pharmacomechanical thrombectomy（PCDT）を追加投与した患者とカテーテル指示溶解（CDT）単独投与した患者の転帰を比較することであった。
OBJECTIVE: Percutaneous thrombus removal is used for the treatment of iliofemoral deep vein thrombosis (DVT), but the efficacy of different treatment modalities has not yet been determined. The aim of this study was to compare the outcomes of patients treated with additional AngioJet pharmacomechanical thrombectomy (PCDT) vs. catheter directed lysis (CDT) alone.
方法:
2011年から2017年の間に症候性急性腸骨大腿部DVTの治療のために血栓溶解療法を受けた全患者を対象にレトロスペクティブレビューを実施した。アウトカム指標は、血栓後症候群（PTS）の発生率、手続き上のアウトカム（溶血曝露）、合併症の発生率、血管の開存率であった。すべての患者を最低1年間追跡調査した。
METHODS: A retrospective review of all patients who received thrombolysis for the treatment of symptomatic acute iliofemoral DVT between 2011 and 2017 was carried out. Outcome measures included the incidence of post-thrombotic syndrome (PTS), procedural outcomes (lytic exposure), the incidence of complications, and vessel patency. All patients were followed up for a minimum of one year.
結果:
治療を受けたのは合計151肢で，PCDTを用いた70肢とCDT単独を用いた81肢であった．人口統計学的データと危険因子の有病率は同等であった。PTSの発生率（1年後のVillaltaスコア）は有意差を示さなかった（PCDT 22.2％ vs. CDT単独24.7％、p=.74）。PCDTの使用は、出血の減少（n=4/63 [6.3％] vs. 13/76 [17.1％]；相対リスク0.37、95％信頼区間[CI] 0.13-1.08；p=.07）、統計学的に有意でない傾向を示した。07）、溶解期間の統計学的に有意な減少（40h [95% CI 34-46] vs. 53h [95% CI 49-58]；p<.001）、およびリチン用量の減少（49mg [95% CI 42-55] vs. 57mg [95% CI 52-61]；p=.011）がCDTと比較して認められた。この減少は、主にAngioJet PowerPulseモードで治療された24例で強調された（27h、95％CI 20-34［p<.001］、42mg、95％CI 34-50［p=.009］）。合併症の発生率は両群間で同等であり，CDT後の頭蓋内出血による死亡は1例であった．PCDT後のヘモグロビン尿の発生率は増加したが（12/63［19.0％］対3/76［3.9％］、p=.006）、急性腎障害には有意差は認められなかった（3/63［4.8％］対1/76［1.3％］、p=.33）。2年間の血管開存率には有意差は認められなかった（p=.73）。
RESULTS: A total of 151 limbs were treated, 70 limbs with PCDT and 81 limbs with CDT alone. Demographic data and prevalence of risk factors were comparable. Incidence of PTS (Villalta score at one year) showed no significant difference (22.2% PCDT vs. 24.7% CDT alone, p = .74). Use of PCDT resulted in a non-statistically significant trend for fewer bleeds (n = 4/63 [6.3%] vs. 13/76 [17.1%]; relative risk 0.37, 95% confidence interval [CI] 0.13-1.08; p = .07), a statistically significant reduction in lysis duration (40 h [95% CI 34-46] vs. 53 h [95% CI 49-58]; p < .001) and a reduction in lytic dose (49 mg [95% CI 42-55] vs. 57 mg [95% CI 52-61]; p = .011) compared with CDT. This reduction was accentuated in 24 cases primarily treated with AngioJet PowerPulse mode (27 h, 95% CI 20-34 [p < .001] and 42 mg, 95% CI 34-50 [p = .009]). Incidences of complications were comparable between groups, with one death due to an intracranial haemorrhage following CDT. Although the incidence of haemoglobinuria was increased following PCDT (12/63 [19.0%] vs. 3/76 [3.9%]; p = .006), no significant difference in acute kidney injury was observed (3/63 [4.8%] vs. 1/76 [1.3%]; p = .33). No significant difference in vessel patency over two years was observed (p = .73).
結論:
腸大腿DVTの治療にPCDTを使用することで、同程度の患者転帰、同程度の血管開存性、許容できる安全性プロファイル、および全リチン量の減少が観察された。
CONCLUSION: The use of PCDT for the treatment of iliofemoral DVT was observed to provide comparable patient outcomes, comparable vessel patency, an acceptable safety profile, and reduced overall lytic dose.
Crown Copyright © 2020. Published by Elsevier B.V. All rights reserved.