Hasan GÜNDOĞDU, İbrahim DUZCAN, Medeni ARPA

Semptomatik Subakut İliofemoral Derin Ven Trombozunun Farmakomekanik Trombektomi ile Endovasküler Tedavisi: Tek Merkez Tedavi Sonuçlarımız

Özet Amaç: Bu çalışmada subakut iliofemoral derin ven trombozu (DVT) tanısıyla farmakomekanik trombektomi (FMT) yöntemi ile tedavi edilen hastalarda tedavinin etkinliğini değerlendirmeyi ve 6 aylık sonuçlarımızı sunmayı amaçladık. Gereç ve Yöntemler: Çalışmaya semptomların başlangıcından itibaren geçen süre 15-28 gün olan, fizik muayenesinde uyluk veya bacakta şişlik, ağrı semptomları olan, renkli doppler ultrasonografide (RDUS) iliofemoral derin venlerde çap artışı ve trombüsü olan hastalar dâhil edildi. Hastalara FMT tedavisi uygulandı. Tedavi sonrası hastalar 1., 3. ve 6. ayda klinik muayene ve RDUS ile kontrol edildi. Retromboz, sağ-sol uyluk çap farkı, venöz yetmezlik varlığı, vizüel analog skala (VAS) ile ağrı derecesi, Villalta skoru ile postrombotik sendrom (PTS) açısından değerlendirildi. Bulgular: Hastaların %83.33’ünde DVT sol bacakta idi. Semptomların süresi ortalama 19.3±2.3 gün idi. DVT gelişimi için hastaların %60’ında en az bir risk faktörü mevcuttu. Teknik başarı hastaların % 90’ında sağlandı. İşlem sonrası hastaların %10’unda erken dönemde girişim yerinde kanama veya hematom gözlendi. Hastaların hiçbirinde cerrahi onarım gerektiren vasküler yaralanma veya psödoanevrizma, major sistemik komplikasyon veya mortalite gelişmedi. Semptom süresi ile kullanılan doku plazminojen aktivatörü (tPA) dozu, trombüs çıkarılma derecesi, teknik başarı ve retromboz arasında istatistiksel olarak anlamlı ilişki saptanmadı (p>0.05). Tüm hastaların; DVT olan bacak ile olmayan bacak arasındaki sağ-sol çap farklarının, VAS skorlarının, Villalta skorlarının 1., 3., 6. ay kontrollerinde istatistiksel olarak anlamlı düşüş izlendi (p< 0.001). Villalta semptom skorlarındaki düşüş ile teknik başarı arasında anlamlı ilişki saptandı (p=0.002).

Anahtar Kelimeler:

Derin ven trombozu, Farmakomekanik trombektomi, İliofemoral, Subakut

Endovascular Treatment of Symptomatic Subacute Iliofemoral Deep Vein Thrombosis with Pharmacomechanical Thrombectomy: Our Single Center Treatment Results

Abstract Objective: In this study, we aimed to evaluate the efficacy of the treatment and present our 6-month results in patients treated with pharmacomechanical thrombectomy (FMT) with the diagnosis of subacute iliofemoral deep vein thrombosis (DVT). Material and Methods: Patients with 15-28 days from the onset of symptoms, swelling in the thigh or leg on physical examination, pain symptoms, and increased diameter and thrombus in the iliofemoral deep veins in color doppler ultrasonography (RDUS) were included in the study. FMT treatment was applied to the patients. Post-treatment patients 1., 3. and at 6. months, clinical examination and color Doppler ultrasonography (RDUS) were checked. Presence of re-thrombosis, right-left thigh diameter difference, presence of venous insufficiency, pain degree with visual analog scale (VAS), and post-thrombotic syndrome (PTS) were evaluated with Villalta score. Results: DVT was in the left leg in 83.33% of the patients. The duration of the symptoms was 19.3±2.3 days on average. Sixty percent of the patients had at least one risk factor for the development of DVT. Technical success was achieved in 90% of the patients. In the early period, bleeding or hematoma at the intervention site was observed in 10% of the patients after the procedure. None of the patients developed vascular injury or pseudoaneurysm requiring surgical repair, major systemic complications or mortality. There was no statistically significant relationship between symptom duration and tissue plasminogen activator (tPA) dose used, degree of thrombus removal, technical success and rethrombosis (p> 0.05). All patients; there was a statistically significant decrease in the right-left diameter differences between the leg with DVT and the leg without the leg, VAS scores, and Villalta scores at the 1st, 3rd, and 6th month controls (p<0.001). There was a significant correlation between the decrease in Villalta symptom scores and technical success (p=0.002). Conclusion: In patients with subacute DVT, FMT is an effective treatment method because it can reduce the risk of PTS with complaints of pain and swelling in the early clinical period.

Keywords:

Deep vein thrombosis, Iliofemoral, Subacute, Pharmacomechanical thrombectomy,

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