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Abstract: A 62-year-old middle-aged male patient presented to the outpatient clinic with swelling of the left lower extremity for 1 month. He complained of swelling of the lower extremity with pain, and was diagnosed with lower extremity venous thrombosis after examination. The patient was recommended to be admitted to the hospital, and after discussion with the patient and his family, it was decided to treat him with Anjiojet mechanical thrombectomy with oral rivaroxaban tablets. After treatment, the patient’s lower extremity swelling and pain disappeared, and the angiography showed that most of the thrombus was cleared.
Basic information】Male, 62 years old
Disease Type】Venous thrombosis of lower extremity
Hospital】Liaoning Provincial People’s Hospital
Consultation date】April 2022
Treatment plan] Anjiojet mechanical aspiration + medication (rivaroxaban tablets)
【Treatment Period】Inpatient treatment for 10 days, outpatient review after 3 months
Treatment effect] The swelling and pain in the lower limbs disappeared, and the imaging showed that most of the thrombus was cleared.
I. Initial consultation
A 62-year-old middle-aged male patient came to the outpatient clinic with swelling of the left lower limb for one month. The patient developed swelling of the left lower limb with no obvious cause one month ago, accompanied by pain, which was obvious after prolonged standing or exertion. The patient said that he was eating and sleeping well, and his bowel movements were normal, and there was no significant weight loss. The patient complained of no previous history of hypertension, diabetes mellitus, heart disease or cerebrovascular disease. Physical examination: uniform and consistent swelling of the left lower limb, skin temperature higher than the contralateral side, slightly red skin color, indentation of the anterior tibial finger (+), gastrocnemius grip pain (+), dorsalis pedis artery pulsation could be reached. Routine blood tests, coagulation function, and D-2 aggregates were completed, suggesting the presence of acute phase thrombosis. Therefore, combined with the patient’s signs and symptoms and examination, the final diagnosis was lower limb venous thrombosis.
II. Treatment history
The patient was recommended to be promptly hospitalized for surgical removal of the thrombus. After the patient and his family agreed, it was decided to use a minimally invasive interventional approach to remove the thrombus. Anjiojet mechanical thrombectomy was accomplished by implanting an inferior vena cava contrast filter under local anesthesia and a left lower extremity venogram. The procedure is the most advanced one at present, in which a thrombus-absorbing catheter is inserted into the thrombus by puncture intervention and then the thrombus is sucked out of the body by negative pressure suction.
III. Treatment effect
The patient’s surgery went smoothly, and the postoperative symptoms were significantly relieved, the swelling and pain in the lower limbs disappeared, and the angiography showed complete clearance of the thrombus in the left common iliac vein and external iliac vein. After 3 days of postoperative observation, the patient expressed no discomfort and was discharged after 10 days of hospitalization. The patient was advised to continue long-term oral anticoagulation therapy with rivaroxaban tablets after discharge and was advised to review the patient in 3 months. At the time of review, the patient indicated that the swelling symptoms were significantly relieved and the gastrocnemius muscle grip pain (-), and the imaging examination suggested that most of the thrombus was cleared, which was a remarkable effect.
IV. Notes
We are glad that the patient’s symptoms were effectively relieved after surgical treatment. Although the disease has been controlled, the following matters still need to be noted.
1. Patients are prone to hemoglobinuria after Anjiojet mechanical thrombectomy, therefore, patients are advised to drink a lot of water to help urinate and accelerate the excretion of broken red blood cells, which usually lasts 1-3 days and does not require special tension.
2. It is recommended that patients should still use rivaroxaban tablets for anticoagulation for at least 3 months after surgery, because even if the thrombus is completely removed, it may cause damage to valve function, and insufficient amount of full course of anticoagulation will have the risk of thrombus recurrence.
V. Personal insight
Anjiojet mechanical aspiration is an emerging minimally invasive intervention that has gradually become the procedure of choice, but not all patients are suitable for this procedure, and the shorter the time of thrombosis, the better the treatment effect. The shorter the time of thrombosis, the better the treatment effect. For thrombosis with a disease duration greater than 2 months, thrombus removal is no longer suitable due to the adhesion of the thrombus to the vessel wall. Therefore, it is important to seek early medical attention and aggressive treatment when venous thrombosis occurs.