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.
WANG Xuhui
,
ZUO Liang
,
YIN Minyi
. Mechanical removal of deep vein thrombosis of lower extremity： Development, controversy, and future prospects[J]. Surgical Research and New Technique, 2025
, 14(3)
: 199
-203
.
DOI: 10.3969/j.issn.2095-378X.2025.03.001
[1] Wendelboe AM, Raskob GE.Global burden of thrombosis:epidemiologic aspects[J]. Circ Res,2016,118(9):1340-1347.
[2] Kahn SR, Comerota AJ, Cushman M,et al.The postthrombotic syndrome:evidence-based prevention,diagnosis,and treatment strategies:a scientific statement from the American Heart Association[J]. Circulation,2014,130(18):1636-1661.
[3] Comerota AJ, Kearon C, Gu CS, et al.Endovascular thrombus removal for acute iliofemoral deep vein thrombosis[J].Circulation,2019,139(9):1162-1173.
[4] Julie W, Elise S, Hui Yin L, et al.Current challenges in the prevention and management of post-thrombotic syndrome—towards improved prevention[J].Int J Hematol,2023,118:547-567.
[5] 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版)[J]. 中华血管外科杂志,2017,2(4):201-208.
[6] Kakkos SK, 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.
[7] Streiff MB, Agnelli G, Connors JM, et al.Guidance for the treatment of deep vein thrombosis and pulmonary embolism[J].J Thromb Thrombolysis,2016,41(1):32-67.
[8] Vedantham S, Goldhaber SZ, Julian JA,et al.Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis[J]. N Engl J Med,2017,377(23):2240-2252.
[9] 朱迪,马坤,周涛,等. 下肢深静脉血栓的介入机械性取栓研究进展[J]. 中国临床研究,2025,38(2):173-177.
[10] 李观强,孙元,张喜成. 经皮机械性血栓清除术治疗下肢深静脉血栓形成的研究进展[J]. 中华普通外科学文献(电子版),2021,15(1):70-74.
[11] 陈虞汾,杰彭,刘建平. 下肢深静脉血栓形成的腔内治疗进展[J]. 临床医学进展,2025,15(5):5.
[12] Wang W, Sun R, Chen Y, et al.Meta-analysis and systematic review of percutaneous mechanical thrombectomy for lower extremity deep vein thrombosis[J]. J Vasc Surg Venous Lymphat Disord,2018,6(6):788-800.
[13] 中国微循环学会周围血管疾病专业委员会下肢静脉腔内治疗专业委员会. 急性下肢深静脉血栓形成腔内治疗专家共识[J]. 血管与腔内血管外科杂志,2023,9(5):513-519.
[14] 汪有锦,徐向贤,周涛,等. AngioJet取栓序贯小剂量尿激酶溶栓对比置管溶栓在急性髂股静脉血栓治疗中的疗效[J]. 中国临床研究,2025,38(2):200-204.
[15] Loffroy R, Falvo N, Guillen K, et al.Single-session percutaneous mechanical thrombectomy using the Aspirex®S device plus stenting for acute iliofemoral deep vein thrombosis:safety,efficacy,and mid-term outcomes[J]. Diagnostics,2020,10(8):544.
[16] 李金勇,刘建龙,刘笑,等. Aspirex机械清栓治疗创伤后急性下肢深静脉血栓形成的临床疗效[J]. 中国普通外科杂志,2022,31(6):735-743.
[17] Lopez R, DeMartino R, Fleming M, et al. Aspiration thrombectomy for acute iliofemoral or central deep venous thrombosis[J]. J Vasc Surg Venous Lymphat Disord,2019,7(2):162-168.
[18] 赵呈祥,段友良,卢军峰. AcoStream经皮机械性血栓清除治疗Cockett综合征合并急性髂股静脉血栓[J]. 中国介入影像与治疗学,2024,21(12):801-803.
[19] 王国华,陈保星,李会朋,等. AcoStream与AngioJet治疗急性髂股静脉血栓形成的疗效比较[J]. 天津医药,2025,53(1):52-56.
[20] Yu Z, Yang T, Cai M, et al.Early outcome of percutaneous mechanical thrombectomy using the AcoStream device in combination with other endovascular therapies for deep vein thrombosis in a lower extremity[J/OL]. Vascular,2025:17085381251347865.doi:10.1177/17085381251347865.Epub ahead of print.
