1、实用医学杂志 2023年第39卷第18期 The Journal of Practical Medicine 2023 Vol.39 No.18急性下肢深静脉血栓形成患者行CDT联合ART治疗前后监测超声弹性成像参数变化对疗效的评估价值潘江皓 孙健铭 宋家明 付广印 雷勇 张晓洁衡水市人民医院(河北衡水 053000)【摘要】目的分析急性下肢深静脉血栓形成(DVT)患者行导管接触性溶栓(CDT)联合AngioJet机械性血栓抽吸术(ART)治疗前后监测超声弹性成像参数变化对疗效的评估价值。方法选择 2021 年8 月至2022年8月衡水人民医院收治的100例DVT患者,所有患者均接受CDT联合
2、ART治疗,术后接受药物治疗,共治疗10 d。观察患者治疗前、治疗10 d后患肢肿胀情况、超声弹性成像参数。根据疗效不同将患者分为无效组和有效组,比较两组基线资料及治疗前超声弹性成像参数;绘制受试者工作曲线(ROC),检验超声弹性成像参数对DVT患者治疗无效的预测价值;采用双相关变量Spearman分析超声弹性成像参数与 DVT 患者治疗无效相关性。结果100 例 DVT 患者经 CDT 联合 ART 治疗后,显效 34 例(34.00%),有效53例(53.00%),无效13例(13.00%);DVT 患者治疗后的患健侧大腿周径差、患健侧小腿周径差相比治疗前小,超声弹性成像评分、应变值、杨氏
3、模量值相比治疗前低(P 0.05);无效组治疗前超声弹性成像评分、应变值、杨氏模量值相比有效组高(P 0,P 0.05)。结论超声弹性成像参数能够有效预测DVT患者CDT联合ART治疗后临床疗效,超声弹性成像参数变化与治疗无效呈正相关。【关键词】急性下肢深静脉血栓;导管接触性溶栓;AngioJet机械性血栓抽吸术;超声弹性成像参数;临床疗效【中图分类号】R543.6Evaluation value of monitoring changes of ultrasonic elastic imaging parameters before and after CDT combined with A
4、RT in patients with acute deep venous thrombosis of lower extremities PAN Jianghao,SUN Jianming,SONG Jiaming,FU Guangyin,LEI Yong,ZHANG Xiaojie.Hengshui Peoples Hospital,Hengshui 053000,China【Abstract】ObjectiveTo analyze the value of monitoring changes in ultrasound elastography parameters before an
5、d after treatment with catheter contact thrombolysis(CDT)combined with AngioJet mechanical thrombus aspiration(ART)in patients with acute lower extremity deep vein thrombosis(DVT)for the assessment of efficacy.MethodsOne hundred patients with DVT admitted to Hengshui people s hospital from August 20
6、21 to August 2022 were selected,and all patients received CDT combined with ART and postoperative medication for 10 d.Patients were observed for swelling of the affected limb before and after 10 d of treatment,ultrasound elastography parameters.Patients were divided into ineffective group and effect
7、ive group according to different curative effects,and baseline data and ultrasonic elastography parameters before treatment were compared between the two groups;the subject operating curve(ROC)was plotted,and the area under the curve(AUC)values were calculated to test the predictive value of ultraso
8、und elastography parameters for treatment ineffectiveness in DVT patients;Spearmans analysis of ultrasound elastography parameters and treatment ineffectiveness in DVT patients was performed using a bivariate correlation variable The correlation between ultrasound elastography parameters and treatme
9、nt ineffectiveness in DVT patients was analyzed using the bicorrelation variable Spearman.ResultsAfter 100 patients with DVT were treated with CDT combined with ART,34(34.00%)were effective,53(53.00%)were effective,and 临 床 研 究doi:10.3969/j.issn.1006-5725.2023.18.013基金项目:河北省医学科学研究课题计划(编号:20220459)236
10、2实用医学杂志 2023年第39卷第18期 The Journal of Practical Medicine 2023 Vol.39 No.1813(13.00%)were ineffective;After treatment,the circumference difference of the affected side thigh and the circumference difference of the affected side calf of DVT patients were smaller than before treatment,and the ultrasonic
11、 elastography score,strain value and Youngs modulus value were lower than before treatment(P 0.05).The ultrasonic elastography score,strain value and Youngs modulus in the ineffective group were higher than those in the effective group before treatment(P 0,P0.05).ConclusionUltrasound elastography pa
12、rameters can effectively predict clinical outcomes after CDT combined with ART in DVT patients,and changes in ultrasound elastography parameters were positively correlated with treatment ineffectiveness.【Key words】acute lower extremity deep vein thrombosis;catheter-contact thrombolysis;angioJet mech
13、anical thrombus aspiration;ultrasound elastography parameters;clinical efficacy急性下肢深静脉血栓(DVT)是指血液在下肢深静脉系统中凝聚成血栓,可阻碍血液回流,使患肢出现肿胀、发红,还可诱发炎症反应,从而造成持续性疼痛,严重影响患者生活质量1。导管接触性溶栓(CDT)是临床治疗 DVT 的常见方式,通过将导管置入静脉血栓内,并注入溶栓药物,可达到溶解血栓、改善患者下肢症状的目的2。AngioJet机械性血栓抽吸术(ART)是将 AngioJet 导管送至血栓的近心端,并使用喷射模式喷射溶栓药物,待血栓溶解、粉碎后,
14、吸出血栓3。CDT联合ART可进一步缓解下肢症状,但仍有部分患者联合治疗后静脉壁仍有血栓黏附,患肢周径下降不明显,出现治疗无效的情况。因此,探寻可有效预测DVT患者 CDT 联合 ART 治疗后临床疗效的评估方法对指导临床治疗具有积极意义。据相关研究显示,血栓形成后的不同时期内组织结构、血栓硬度存在明显差异,而血栓硬度与溶栓药物敏感度有一定联系4。超声属于临床常用检测方法,其中超声弹性成像可通过定量评估、成像组织弹性模量反映组织内部弹性或硬度方面的信息,在诊断血栓中取得不错效果。但目前,临床关于超声弹性成像在DVT疗效评估相关报道较少。鉴于此,本研究着重分析 DVT 患者行 CDT 联合 AR
15、T 治疗前后监测超声弹性成像参数变化对疗效的评估价值,以期为该病治疗方案的指导提供参考。现报告如下。1资料与方法1.1一般资料研究经医院医学伦理委员会审核批准(批准文号:2021-3-009 号)。选择 2021 年8月至2022年8月衡水人民医院收治的100例DVT患者作为研究对象,患者中男 49 例,女 51 例;年龄 51 67岁,平均(59.30 2.47)岁;患侧:左下肢47例,右下肢53例;病理类型:中心型血栓17例,混合型血栓 83 例。纳入排除标准:(1)DVT 符合深静脉血栓形成的诊断和治疗指南(第三版)5中诊断标准,并经超声造影检查确诊;(2)均接受CDT 联合 ART 治
16、疗;(3)单侧发病;(4)患者及家属均签署知情同意书。排除标准:(1)合并感染性疾病者;(2)合并血液系统疾病者;(3)合并严重心脑血管疾病者;(4)合并恶性肿瘤者。1.2方法1.2.1CDT联合ART治疗方法对患者患肢行造影检查,了解血栓分布情况,检测股静脉行穿刺,于肾静脉开口下方置入下腔静脉滤器DL950F(Bard Peripheral Vascular,Inc.,国械注进 20163131181),植入16枚可回收滤器、3枚临时滤器、1 枚永久滤器。穿刺患侧股静脉或腘静脉,将导丝(Boston Scientific Corporation,国械注进20173037238)送至下腔静脉,
17、沿导丝将 AngioJet 导管(Boston Scientific Corporation,国械注进 20213030170)送至血栓近心端,使用喷射模式在血栓内喷射尿激酶(成都通德药业有限公司,规格:50万单位,国药准字H51021402),剂量为 20 万 U,15 min 后,使用碎吸模式将 AngioJet 导管逐步后撤碎吸血栓,直至造影结果显示清除大部分血栓,总时间控制在300 s内,随后退出AngioJet导管。展开CDT治疗,将溶栓导管置入静脉血栓内,通过微泵(B.Braun Melsungen AG,国械注进 20192140298)持续泵入尿激酶(75万U/d)、肝素(SA
18、NOFI WINTHROP INDUSTRIE,规格:0.8 mL:8000AaIU,国药准字HJ20170271)剂量为100 mg/d,期间脉冲式给药每天4次。1.2.2术后治疗术后尿激酶3050万U溶于生理盐水持续泵入,2 次/d,每 24 小时复查造影,期间定时检测凝血功能,当纤维蛋白原 1.0 g/L 时停止泵入。出院后口服硫酸氢氯吡格雷片(Sanofi 2363实用医学杂志 2023年第39卷第18期 The Journal of Practical Medicine 2023 Vol.39 No.18Winthrop Industrie,规 格:75 mg(按 C16H16ClN
19、O2S计),国药准字HJ20171237)1片/d,阿司匹林片(大同市利群药业有限责任公司,规格:0.5 g 10 s,国药准字H14020485)1片/d,连续用药10 d。1.2.3 临床疗效评估及分组方法 于治疗10 d时,患者行二维超声检查,显效:血管壁光滑,管径正常,血栓基本溶解,彩色多普勒显示管腔内血流通畅,静脉完全再通,肢体肿胀、疼痛等临床症状消失;有效:溶栓部分溶解,彩色多普勒显示管腔内探及部分血流信号,梗阻静脉部分再通,患者患肢肿胀及疼痛症状减轻;无效:未见血栓溶解,彩色多普勒未探及血流信号,梗阻静脉仍完全梗阻,临床症状未有改善。将显效、有效患者纳入有效组,将无效患者纳入无效
20、组。1.3 观察指标(1)临床疗效:记录显效、有效及无效患者数,将显效、有效的患者纳入有效组,将无效的患者纳入无效组;(2)患肢肿胀情况:记录患者治疗前、治疗10 d后患健侧大腿周径差、患健侧小腿周径差;(3)超声弹性成像参数:于患者治疗前、治疗10 d时,使用超声诊断系统SONIMAGE HS1 PLUS(柯尼卡美能达株式会社,国械注进20172061587)行超声弹性成像检测,患者取平卧位,双腿稍分开,患肢稍外旋,充分暴露检查部位,探头垂直于体表血栓部位作快速轻压轻放震动,当仪器数字指标在60 80范围时冻结保存图像,重复3次,取平均值,成像后使用仪器自带软件进行分析;超声弹性成像评分:采
21、用 5 分法评价:红色(1分),红色与绿色相间(2分),绿色(3分),绿色与蓝色相间(4)分,蓝色(5 分),评分越高硬度越高;应变值:感兴趣区域血栓部位为A区,周围肌肉组织为B区,计算两个区域内组织应变值;杨氏模量值:应力/应变=(F/A)/(L/L),F/A为应力,L为外力作用于物体上的拉伸长度,L表示为物体的原始长度。1.4统计学方法采用 SPSS 24.0 软件进行数据处理,以(x s)表示计量资料,治疗前后比较采用配对样本t检验;计数资料用例(%)表示,采用2检验;制受试者工作曲线(ROC),并计算曲线下面积(AUC)值,检验超声弹性成像参数对DVT患者治疗无效的预测价值;采用双相关
22、变量 Spearman分析,超声弹性成像参数与DVT患者治疗无效相关性;P 0.05为差异有统计学意义。2结果2.1患者临床疗效情况100例DVT患者经CDT联合ART治疗后,显效34例(34.00%),有效53例(53.00%),无效13例(13.00%)。2.2患者治疗前后患肢肿胀情况比较DVT患者经治疗后,患健侧大腿周径差、患健侧小腿周径差相比治疗前小(P 0.05)。见表1。2.3患者治疗前后超声弹性成像参数比较DVT患者经治疗后,超声弹性成像评分、应变值、杨氏模量值相比治疗前低(P 0.05)。见表2。2.4两组基线资料及超声弹性成像参数比较无效组治疗前超声弹性成像评分、应变值、杨氏
23、模量值相比有效组高(P 0.70,有一定预测价值,其中联合检测最高。见表4。2.6超声弹性成像参数与DVT 患者临床疗效的相关性采用双相关变量 Spearman 分析,结果显示,超声弹性成像评分、应变值、杨氏模量值与DVT 患者治疗无效呈正相关(r 0,P 0.05)。见表5。3讨论DVT 是引发血栓综合征、肺栓塞等多种严重表1患者治疗前后患肢肿胀情况Tab.1The swelling of the affected limb before and after treatment x s,cm时间治疗前(n=100)治疗后(n=100)t值P值患健侧大腿周径差8.32 1.492.75 1.0
24、629.969 0.001患健侧小腿周径差2.38 1.181.54 0.736.054 0.001表2患者治疗前后超声弹性成像参数比较Tab.2Comparison of ultrasonic elastography parameters of patients before and after treatmentx s时间治疗前(n=100)治疗后(n=100)t值P值超声弹性成像评分/分3.02 0.461.24 0.1935.765 0.001应变值1.47 0.210.59 0.1137.121 0.001杨氏模量值/kPa23.15 4.0611.18 2.4325.298 0.
25、0012364实用医学杂志 2023年第39卷第18期 The Journal of Practical Medicine 2023 Vol.39 No.18并发症的危险因素,如未及时治疗,随着病情进展可严重影响患者生活质量,甚至生命安全6。CDT是临床治疗DVT的常用手段,可通过在血栓内直接使用溶栓药物,以促进血栓溶解,改善患者下肢血液循环7。但常规 CDT 药物溶栓时间较长、溶栓效果一般,故常与ART联合治疗8。POUNCEY等9研究报道,CDT 联合 ART 治疗后约 82%DVT患者的临床症状得到改善,与本研究较为相似,表明 CDT 联合 ART 治疗 DVT 临床疗效较高。但仍有部分
26、患者在CDT联合ART治疗后的效果不佳,影响患者预后。因此,临床需积极寻找可有效评估 DVT 患者 CDT 联合 ART 治疗后临床疗效的指标,针对治疗无效风险较高者采取针对性防治措施,对提升DVT患者临床疗效有积极意义。表3两组基线资料及超声弹性成像参数比较Tab.3Comparison of baseline data and ultrasonic elastography parameters between two groups例(%)资料性别 男 女年龄 60岁 60岁体质量指数 24 kg/m2 24 kg/m2患侧 左下肢 右下肢病理类型 中心型血栓 混合型血栓患健侧大腿周径差(
27、x s,cm)患健侧小腿周径差(x s,cm)静脉通畅评分(x s,分)超声弹性成像评分(x s,分)应变值(x s,cm)无效组(n=13)8(61.54)5(38.46)6(46.15)7(53.85)9(69.23)4(30.77)7(53.85)6(46.15)3(23.08)10(76.92)8.14 1.862.87 1.098.09 1.353.48 0.681.64 0.26有效组(n=87)41(47.13)46(52.87)33(37.93)54(62.07)51(58.62)36(41.38)40(45.98)47(54.02)14(16.09)73(83.91)8.40
28、 1.442.21 1.217.57 1.172.91 0.411.38 0.192/t值0.9400.3210.5310.2810.0530.5841.8561.4654.2434.374P值0.3320.5710.4660.5960.8180.5610.0660.146 0.001 0.001表4超声弹性成像参数对DVT患者治疗预后的预测价值Tab.4Predictive value of ultrasonic elastography parameters for treatment and prognosis of DVT patients因素超声弹性成像评分应变值杨氏模量值联合检测A
29、UC0.8030.7930.7710.946cut-off值3.335分1.42526.345 kPa95%CI0.618 0.9870.652 0.9330.612 0.9290.879 1.000P值 0.0010.0010.002 0.001特异度0.8620.6090.8510.908灵敏度0.7690.8460.7690.923约登指数0.6310.4550.6200.831ROC曲线曲线来源超声弹性成像评分应变值杨氏模量值联合评估参考线0.0 0.2 0.4 0.6 0.8 1.01-特异度1.00.80.60.40.20.0敏感度图1超声弹性成像参数对DVT患者治疗预后的预测价值
30、Fig.1The predictive value of ultrasonic elastographyparameters for the prognosis of DVT patients2365实用医学杂志 2023年第39卷第18期 The Journal of Practical Medicine 2023 Vol.39 No.18研究10发现,早期血栓中存在大量红细胞及少数白细胞,随病情进展后,胶原合成纤维细胞组织成为静脉血栓的主要成分,使血栓与血管壁紧密结合,提高血栓稳定性,从而导致溶栓药物难以进入血栓内部溶解血栓,进而影响患者临床疗效。由此可见,监测DVT患者血栓硬度变化可能对
31、评估患者临床疗效有一定意义。超声弹性成像是评估病灶软硬度的重要检查手段,其利用人体内多种组织间弹性差异,通过探头对皮肤组织施加内外部激励,收集压缩前后射频信息,根据组织内部变化评估病灶的硬度情况10-11。SIVAKUMARAN等12研究报道,超声弹性成像能够有效评估不同阶段的静脉血栓。但关于超声弹性成像在评估DVT患者临床疗效中是否也可取得相似成效尚未见相关报道。本次研究结果显示,DVT 患者治疗后的患健侧大腿周径差、患健侧小腿周径差与超声弹性成像评分、应变值、杨氏模量值相比治疗前低,表明CDT联合ART治疗能够有效改善DVT患者临床症状,溶解血栓。原因可能在于:ART利用高速喷出的液体产生
32、负压,将血栓吸入导管并击碎,吸出体外。而CDT则在血栓内注入溶栓药物尿激酶,尿激酶可激活纤维蛋白溶酶原,转化为具有活性纤维蛋白溶解酶,从而溶解纤维蛋白凝块、降解血栓,改善患者下肢血流状况,缓解患者临床症状,降低血栓硬度13-14。本研究还发现,无效组治疗前超声弹性成像评分、应变值、杨氏模量值相比有效组高,采用双相关变量 Spearman 分析,结果显示,超声弹性成像评分、应变值、杨氏模量值与DVT 患者治疗无效呈正相关,表明血栓硬度与DVT患者CDT联合ART治疗效果关系密切,而降低血栓硬度对提升 DVT 患者治疗效果有积极意义。早期DVT患者血栓机化结构较松散、硬度较低,质地较为松软,更容易
33、被ART负压冲碎吸出,便于CDT插入血栓注入尿激酶,进而保证临床疗效15-16。尿激酶是一种由人肾小管上皮细胞分泌的蛋白水解酶,半衰期约为15 min,可通过激活纤溶酶原发挥降解纤维蛋白的作用,稳定性较好,用于置管溶栓中可减少药物稀释时间,维持血栓周围药物浓度17-18。但如血栓硬度较高,导管难以插入血栓中,药物无法顺利进入血栓内部,从而影响溶栓效果。同时由于硬度较高,ART负压难以冲碎血栓,降低血栓清除率,进而降低临床疗效19-20。此外,血栓硬度高往往代表血栓形成时间较长,血栓中纤维蛋白成分可逐步转变为交联的纤维蛋白,该形式的纤维蛋白对溶栓药物不敏感,也进一步降低DVT患者CDT联合ART
34、临床疗效21-22。本研究进一步绘制 ROC 曲线结果显示,超声弹性成像评分、应变值、杨氏模量值水平及联合检测预测 DVT 患者 CDT 联合 ART 治疗后临床疗效的AUC均0.70,有一定预测价值,其中联合检测最高,表明超声弹性成像参数能够有效预测DVT患者CDT联合ART治疗后临床疗效,提示临床应密切监测超声弹性成像参数变化,并针对治疗无效风险高的患者制定个性化治疗方案,以提高临床疗效。综上所述,超声弹性成像参数能够有效预测DVT患者CDT联合ART治疗后临床疗效,超声弹性成像参数变化与治疗无效呈正相关。【Author contributions】PAN Jianghao perform
35、ed the experiments and wrote the article.PAN Jianghao performed the experiments.SUN Jianming and SONG Jiaming Xiqi revised the article.FU Guangyin,LEI Yong and ZHANG Xiaojie designed the study and reviewed the article.All authors read and approved the final manuscript as submitted.参考文献1 SEGERS P,HEN
36、DRIKS B M F,HEUTS S,et al.Deep Venous Thrombosis With Symptomatic Bilateral Pulmonary Embolism After Using an Infrapatellar Strap for Patellofemoral Pain in an Athletic Cardiothoracic SurgeonJ.Clin J Sport Med,2021,31(6):e509-e511.2 VEDANTHAM S,SALTER A,LANCIA S,et al.Clinical Outcomes of a Pharmaco
37、mechanical Catheter-Directed Venous Thrombolysis Strategy that Included Rheolytic Thrombectomy in a Multicenter Randomized TrialJ.J Vasc Interv Radiol,2021,32(9):1296-1309.e7.3 XU Y,WANG X,SHANG D,et al.Outcome of AngioJet mechanical thrombus aspiration in the treatment of acute lower ex表5超声弹性成像参数与D
38、VT患者临床疗效的相关性Tab.5Correlation between ultrasonic elastography parameters and clinical efficacy of DVT patients指标临床疗效超声弹性成像评分应变值杨氏模量值临床疗效-r=0.398,P=0.000r=0.411,P=0.000r=0.330,P=0.001超声弹性成像评分r=0.398,P 0.001-r=0.148,P=0.143r=0.039,P=0.701应变值r=0.341,P=0.000r=0.148,P=0.143-r=0.088,P=0.384杨氏模量值r=0.330,P=0
39、.001r=0.039,P=0.701r=0.088,P=0.384-2366实用医学杂志 2023年第39卷第18期 The Journal of Practical Medicine 2023 Vol.39 No.18tremities deep venous thrombosisJ.Vascular,2021,29(3):415-423.4 MATSUOKA A,KOAMI H,SHINADA K,et al.Investigation of differences in coagulation characteristics between hospitalized patients
40、with SARS-CoV-2 Alpha,Delta,and Omicron variant infection using rotational thromboelastometry(ROTEM):A single-center,retrospective,observational study J.J Clin Lab Anal,2022,36(12):e24796.5 VASCULAR SURGERY GROUP,SURGICAL BRANCH OF CHINESE MEDICAL ASSOCIATION.Guidelines for the diagnosis and treatme
41、nt of deep vein thrombosis(third edition)J.Chin J Vasc Surg,2017,9(4):201-208.6 TU L K,NIE M L,FU J,et al.Comparing the efficacy of endovascular treatment for iliac vein compression syndrome with or without acute deep venous thrombosis:A single-center retrospective study J.Vascular,2022,30(2):341-34
42、8.7 ELKHOULY A,ENOS D,FOX J.Retraction:Ultrasound-Facilitated Catheter-Directed Thrombolysis via Dual Right Upper Extremity Venous Access Into the Basilic Vein in a Case of Submassive Pulmonary Embolism J.Cureus,2021,13(3):r23.8 ZHENG X,XUE M,ZHOU Y,et al.Effectiveness of pigtail catheter crushing c
43、ombined with AngioJet mechanical aspiration for treatment of acute left iliofemoral vein thrombosis J.Asian J Surg,2022,45(1):226-231.9 POUNCEY A L,GWOZDZ A M,JOHNSON O W,et al.AngioJet Pharmacomechanical Thrombectomy and Catheter Directed Thrombolysis vs.Catheter Directed Thrombolysis Alone for the
44、 Treatment of Iliofemoral Deep Vein Thrombosis:A Single Centre Retrospective Cohort StudyJ.Eur J Vasc Endovasc Surg,2020,60(4):578-585.10PARAMALINGAM S,MORGAN K,BECCE F,et al.Conventional ultrasound and elastography as imaging outcome tools in autoimmune myositis:A systematic review by the OMERACT u
45、ltrasound group J.Semin Arthritis Rheum,2021,51(3):661-676.11FANG S,CHANG L,CHEN F,et al.Endobronchial Ultrasound Elastography Combined With Computed Tomography in Differentiating Benign from Malignant Intrathoracic Lymph NodesJ.Surg Innov,2021,28(5):590-599.12SIVAKUMARAN L,ALTURKISTANI H,LEROUGE S,
46、et al.Strain Ultrasound Elastography of Aneurysm Sac Content after Randomized Endoleak Embolization with Sclerosing vs.Non-sclerosing Chitosan-based Hydrogels in a Canine ModelJ.J Vasc Interv Radiol,2022,33(5):495-504.13NOTTEN P,DE SMET AAEA,TICK L W,et al.CAVA(Ultrasound-Accelerated Catheter-Direct
47、ed Thrombolysis on Preventing Post-Thrombotic Syndrome)Trial:Long-Term Follow-Up Results J.J Am Heart Assoc,2021,10(11):e018973.14FARROKHI M,KHURSHID M,MOHAMMADI S,et al.Comparison of ultrasound-accelerated versus conventional catheter-directed thrombolysis for deep vein thrombosis:A systematic revi
48、ew and meta-analysis J.Vascular,2022,30(2):365-374.15LEE J K,KIM K Y,BYUN S J,et al.Safety and Efficacy of Aspiration Thrombectomy or Pharmacomechanical Thrombectomy after Catheter-Directed Thrombolysis for the Treatment of Acute Iliofemoral Deep Vein Thrombosis J.Vasc Specialist Int,2020,36(3):144-
49、150.16SIVAKUMARAN L,ALTURKISTANI H,LEROUGE S,et al.Strain Ultrasound Elastography of Aneurysm Sac Content after Randomized Endoleak Embolization with Sclerosing vs.Non-sclerosing Chitosan-based Hydrogels in a Canine ModelJ.J Vasc Interv Radiol,2022,33(5):495-504.17ZHANG R,LUO S,HAO L K,et al.Prepara
50、tion and Properties of Thrombus-Targeted Urokinase/Multi-Walled Carbon Nanotubes(MWCNTs)-Chitosan(CS)-RGD Drug Delivery SystemJ.J Biomed Nanotechnol,2021,17(9):1711-1725.18NAN D,JIN H,YANG D,et al.Combination of Polyethylene Glycol-Conjugated Urokinase Nanogels and Urokinase for Acute Ischemic Strok