下肢深静脉血栓形成（DVT）是血管外科常见且严重的疾病,可导致致命性肺栓塞（PE）和严重影响生活质量的血栓形成后综合征（PTS）。传统抗凝治疗虽为基石,但对已形成的血栓清除效果有限,故PTS发生率居高不下（20%~50%）;且对于广泛性髂股静脉血栓（如股青肿）患者,单纯抗凝难以避免高风险的肢体坏疽。置管溶栓术（CDT）虽曾带来希望,但关键研究（如ATTRACT试验）表明其未能显著降低远期PTS发生率且增加出血风险。经皮机械血栓清除术（PMT）作为一种创新的物理血栓清除技术,近10年发展迅速,不断有新型高效设备涌现并获得国内外指南推荐。本文从PMT技术兴起的背景、核心优势与指南定位出发,系统评述了主流PMT设备的技术原理、临床证据与安全性特点,分析了当前面临的关键挑战,并聚焦其未来发展前景,提出智能化精准化、效能提升、成本控制及高质量循证研究等亟待解决的方向。
Deep vein thrombosis （DVT） of the lower extremity is a common and serious condition in vascular surgery, and can lead to fatal pulmonary embolism （PE） and post-thrombotic syndrome （PTS）, severely affecting quality of life. Although traditional anticoagulation therapy serves as the cornerstone, it has limited efficacy in removing established thrombi. Consequently, the incidence of PTS remains persistently high （20%‒50%）. Furthermore, for patients with extensive iliofemoral vein thrombosis （e.g., phlegmasia cerulea dolens）, anticoagulation alone is insufficient to prevent high-risk limb gangrene. Catheter-directed thrombolysis （CDT） has shown promise, but pivotal studies （e.g., the ATTRACT trial） have demonstrated that it fails to significantly reduce the incidence of long-term PTS and increases the risk of bleeding. Percutaneous mechanical thrombectomy （PMT）, as an innovative physical thrombectomy technology, has developed rapidly over the past decade. New and efficient devices have emerged and have been recommended by domestic and international guidelines. Based on the background, core advantages, and guideline positioning of PMT technology, this paper systematically reviewed the technical principles, clinical evidence, and safety characteristics of mainstream PMT devices. It analyzed the key challenges currently faced, focused on their future development prospects, and proposed directions that need to be urgently addressed, such as intelligent precision, efficiency improvement, cost control, and high-quality evidence-based research.
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