Samalani siteji ya kuchotsa thrombus

Opaleshoni ya thrombectomy ndi njira yomwe imatha kuchotsa msanga thrombus munthawi yochepa.Pambuyo pa kuchotsedwa kwa thrombus, mitsempha yotsekedwa idzabwerera ku patency, ndipo chidziwitso chabwino cha nthawi yayitali chikhoza kutheka mwa kuchotsa kwathunthu thrombus kupyolera mu opaleshoni.Chifukwa cha kuvulala kwakukulu, kutuluka magazi ndi zovuta za opaleshoni, palibe zipatala zambiri zomwe zimapanga kafukufuku wachipatala.

M'zaka zaposachedwa, kugwiritsa ntchito mankhwala a thrombolytic komanso kukula mwachangu kwaukadaulo wa intravascular kumapangitsa lingaliro la "thrombus clearance" kukhalapo.Pamaziko a anticoagulation therapy, chithandizo cha thrombolytic chitha kuwonedwa ngati njira yokhazikika komanso yothandiza, yomwe ili yoyenera kwa odwala a DVT omwe samapatula zotsutsana ndi thrombolytic.

Pakadali pano, urokinase (UK) ndi alteplase ndi omwe amagwiritsidwa ntchito kwambiri ndi fibrinolytic agents mu DVT Clinic thrombolytic therapy kunyumba ndi kunja.Kuchiza kwa thrombolytic kumatha kufulumizitsa kukonzanso kwa thrombolytic, kuteteza ntchito ya valve, kuchepetsa zochitika za PTS, ndipo kusintha kwa moyo wa odwala kumayenderana ndi kuchuluka kwa thrombolysis.Chithandizo cha thrombolytic chingagawidwe mu zotumphukira venous thrombolysis (systemic thrombolysis) ndi catheter directed thrombolysis (CDT).

Ndi kusintha kwa zida zothandizira komanso ukadaulo, CDT ili ndi zabwino zowonekera pochiza DVT.Imalumikizana mwachindunji ndi thrombus wamba ndi mankhwala a thrombolytic, omwe amawonjezera kuchuluka kwa mankhwala a thrombolytic kuzungulira thrombus.Malo olumikizana pakati pa mankhwala a thrombolytic ndi thrombus ndi aakulu kwambiri kuposa a peripheral venous thrombolysis.Chithandizo cha CDT chimachulukitsa kwambiri kuchuluka kwa mankhwala omwe amagwira ntchito pa thrombus, kumawonjezera kwambiri kuchuluka kwa mitsempha yamagazi pambuyo pa thrombolysis, ndipo zotsatira zochiritsira zimakhala zabwino kwambiri kuposa zotumphukira za venous thrombolysis.

CDT yakhala njira yomwe imagwiritsidwa ntchito kwambiri pakalipano, yomwe imatha kuchepetsa mavuto obwera chifukwa cha magazi ndikufulumizitsa thrombolysis.Pharmaceutical mechanical thrombectomy (PMCT) ndi chipangizo chozungulira kumapeto kwa mutu, chomwe chimatha kuphwanya thrombus ndikuyamwa mu catheter kupyolera mu kupanikizika koipa, ndiyeno kuphatikiza ndi CDT yachikhalidwe, yomwe ingachepetse mlingo wa mankhwala a thrombolytic ndi nthawi ya mankhwala pafupifupi. 50%.

Mphamvu ya thrombus clearance ya PMCT ndi CDT ndi yofanana, koma PMCT ndi yotetezeka, imathandizira kukonzanso kwa thrombus, imachepetsa nthawi ya chithandizo, imachepetsa kugwiritsa ntchito mankhwala a thrombolytic ndi mavuto otaya magazi, imachepetsa kuchuluka kwa PTS, imachepetsa kuchuluka kwa masiku m'chipatala ndikuchepetsa mtengo wachipatala.

Kafukufuku wa Cavent ndi kafukufuku wopangidwa mwachisawawa wa mankhwala oletsa magazi oletsa magazi kuphatikizika ndi CDT komanso mankhwala oletsa magazi oletsa magazi pa acute iliofemoral deep vein thrombosis, omwe adalemba odwala ku zipatala za 20 kumpoto chakumadzulo kwa Norway.

Zotsatira za phunziroli zikuwonetsa kuti poyerekeza ndi mankhwala a anticoagulant okha, chithandizo cha CDT chophatikizana chingachepetse kwambiri chiopsezo cha PTS, koma kumawonjezera pang'ono chiopsezo chotaya magazi.Komabe, poyerekezera ndi systemic thrombolysis, ngozi ya magazi imeneyi ikuwoneka yovomerezeka.

Chotsatirachi chimathandizira malingaliro a malangizo aposachedwa omwe kuphatikiza mankhwala a CDT angaganizidwe mwa odwala omwe ali ndi proximal deep vein thrombosis komanso chiopsezo chochepa cha magazi.