Objective To investigate the efficacy and safety of combined catheter-directed thrombolysis and anticoagulation for acute pulmonary embolism combined with lower limb deep vein thrombosis.Methods A retrospective analysis was conducted using a case-control study approach on the clinical data of 58 patients with acute pulmonary embolism who received treatment at the Inner Mongolia Autonomous Region People's Hospital from August 2021 to August 2023.These patients were categorized into two groups based on whether they had lower-limb deep vein thrombosis or not.The group with pulmonary embolism alone(n=14)underwent targeted catheter thrombolysis in combination with anticoagulation treatment using low molecular-weight heparin.The group with both pulmonary embolism and deep vein thrombosis in the lower limbs(combined group,n=44)received inferior vena cava filter placement,along with targeted catheter thrombolysis and anticoagulation treatment with low-molecular weight heparin.The improvement in pulmonary circulation was observed before and after the surgical interventions in both groups.A comparison was made regarding the improvement in indicators including arterial oxygen pressure,fingertip oxygen saturation,the proportion of pulmonary artery trunk thrombosis area to pulmonary artery trunk area,and respiratory rate,both before and after pulmonary artery catheterization and thrombolysis in both groups.Results The surgery was successful for all patients.The symptom of shortness of breath was obviously relieved after surgery.After surgery,in the pulmonary embolism alone group,the respiratory rate was(22.75±4.38)beats/min,the mean pulmonary artery pressure was(32.53±3.63)mmHg(1 mmHg=0.133 kPa),the arterial oxygen partial pressure was(81.46±7.24)mmHg,and the fingertip oxygen saturation was(90.53±4.57)％,respectively.In the combined group,the respiratory rate,mean pulmonary artery pressure,arterial oxygen partial pressure,and fingertip oxygen saturation were(23.35±5.8)beats/min,(31.34±4.53)mmHg,(82.34±4.62)mmHg,and(92.57±3.45)％,respectively.After surgery,the respiratory rate,pulmonary artery pressure,arterial oxygen partial pressure,and fingertip oxygen saturation in each group were significantly higher compared with the corresponding levels before surgery(t=6.33,12.12,17.32,8.13,6.86,13.02,15.52,7.20,all P＜0.001).The proportion of pulmonary artery trunk thrombosis area to pulmonary artery trunk area in the group with pulmonary embolism alone was(19.56±7.53)％,while in the combined group,it was(20.63±4.83)％.After surgery,the proportion of pulmonary artery trunk thrombosis area to pulmonary artery trunk area in each group decreased compared with the corresponding value before surgery(t=19.36,18.23,both P＜0.001).Conclusion The surgical method combining catheter-directed thrombolysis with inferior vena cava filter placement is effective and safe for the treatment of acute pulmonary embolism combined with deep vein thrombosis in the lower limbs.
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