Zhongguo linchuang yanjiu (Feb 2025)
Application of different approaches in interventional thrombolysis of deep vein thrombosis of lower extremities
Abstract
Objective： To investigate the application effects of the popliteal vein approach versus the infrapatellar vein approach in interventional thrombolysis for the treatment of deep vein thrombosis (DVT) in the lower extremities, and its impact on thromboelastography (TEG) parameters, coagulation function, and cell adhesion factor levels. Methods：A total of 78 DVT patients from the Affiliated Hospital of Hebei University of Engineering, between August 2022 and August 2023, were selected and randomly divided into two groups, with 39 patients in each group. Interventional thrombolysis was conducted via the popliteal vein approach in observation group, and via infrapatellar vein approach in control group. Perioperative indicators and thrombus clearance effects were observed in both groups. The swelling of the affected limb, TEG parameters ［reaction time (R value), kinetic time (K value)］, coagulation indexes ［fibrinogen (Fib), D-dimer (D-D)］, and levels of cell adhesion factors ［vascular cell adhesion molecule-1 (VCAM-1), platelet endothelial cell adhesion molecule-1 (PECAM-1), P-selectin］ were analyzed and compared before and after surgery, as well as the incidence of complications. Patients were followed up for one year after discharge, and the Villalta score was used to assess prognosis. Results：The observation group had shorter surgical times, reduced X-ray exposure times, and lower contrast agent doses compared to the control group (P＜0.05). There was no statistically significant difference in thrombus clearance effects between the two groups (Z=0.187, P=0.951). One week after surgery, the circumferences of the calf and thigh in both groups showed a significant reduction compared to preoperative measurements (P＜0.05). One-week post-surgery, R and K values increased significantly in both groups, while Fib, D-D, VCAM-1, PECAM-1, and P-selectin levels decreased significantly compared to preoperative values (P＜0.05). There was no statistically significant difference in the incidence of complications during hospitalization between the two groups （2.56% vs 15.38%, χ2=2.511, P=0.113）. At one-year follow-up, there was no statistically significant difference in the distribution of Villalta scores (Z=0.027, P=0.978). Conclusion：Both the popliteal vein approach and the infrapatellar vein approach for interventional thrombolysis effectively clear thrombus, improve coagulation function, and reduce limb swelling in DVT patients, with good long-term effects and safety. Although the former approach has distinct advantages in terms of surgical time, X-ray exposure time, and contrast agent usage, the actual choice of approach should be determined based on the individual patient's condition.
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