摘要
目的探讨急性全下肢深静脉血栓形成(DVT)多种介入技术联合治疗的临床价值及效果。方法本组291例全下肢DVT患者。髋上髂、股静脉段血栓清除,局麻下逆行穿刺患侧股静脉,导丝引导下插入12～14 F鞘管直接机械性血栓抽吸;髋下股、腘静脉段血栓清除,采用多种介入技术联合处理,即经健侧股静脉顺行穿刺插入4～5 F Cobra导管,导管辅助下亲水超滑导丝插至患侧髂、股静脉内,采用穿线或导丝抓捕技术,将导丝经患侧股静脉穿出体外,建立工作导丝通路,再沿工作导丝由健侧置入翻山鞘管至患侧髂、股静脉内,加长亲水超滑导丝在翻山鞘管支撑下轻柔的越过瓣膜插至患侧股、腘静脉内,DSA监视下Fogarty拉栓球囊沿导丝顺应静脉瓣膜方向将血栓拉至患侧髂静脉内,再经患侧股静脉进行机械性抽吸血栓。对存在的髂静脉狭窄或闭塞,行PTA或支架植入治疗;腘静脉以下血栓行溶栓治疗。结果手术成功率100%,术后1～3 d患肢肿胀、疼痛均开始消退或减轻。血栓完全清除率86.3%;出院时健、患肢膝上、下15 cm处周径差分别为(1.64±0.43)和(0.97±0.42)cm,176例合并髂总静脉狭窄或闭塞行PTA和支架植入治疗。279例随访3～12个月,水肿、色素沉着、溃疡等后遗症发生率分别为8.24%、3.94%、0;彩色多普勒超声复查静脉通畅无附壁血栓89.3%;临床总有效率98.2%。结论多种介入技术联合治疗急性全下肢DVT,血栓完全清除率高,最大程度保护静脉瓣功能,住院周期短,是安全有效的方法。
Objective To investigate the clinical value and effect of combination therapy by using multiple interventional technologies for acute deep venous thrombosis. Methods A total of 291 patients with deep venous thrombosis （DVT） of lower extremities were enrolled in this study. Under local anesthesia, thrombeetomy of iliofemoral venous thrombosis above the hip was performed. The puncturing needle was inserted in retrograde direction into the femoral vein on the affected side, and then a 12 - 14 F sheath was introduced via a guide-wire to aspirate iliofemoral thrombus. For the removal of femoropopliteal thrombus, a variety of interventional techniques were employed. The whole procedure was as follows. Anterograde puncturing of a 4 - 5 F cobra catheter via the femoral vein on the healthy side was performed first, then with the help of the catheter a hydrophilic super-slippery guide-wire was advanced to the place where the diseased inferior vena cava and iliac vein joined, by using ＂threading＂ or ＂capturing＂ technique the guide-wire was pulled out through the femoral vein on the affected side. Thus a pathway of ＂working guide- wire＂ was established. Along the ＂working guide-wire＂ a ＂crossing sheath＂ was inserted from the healthy side to theaffected iliofemoral vein. Supported by the ＂crossing sheath＂, the lengthening hydrop- hilic super-slippery guide-wire strode over the venous valve and reached to the femoropopliteal vein on the affected side. Under DSA monitoring, a Fogarty ballooncatheter was introduced into the femoropopliteal vein to pull the thrombus to the iliac vein on the affected side, which was followed by mechanical aspiration thrombectomy. For the coexisting stenosis or occlusion of iliac vein, which was demonstrated on venography, percutaneous transluminal angioplasty（PTA） was adopted. For the thrombus located below the popliteal vein thrombolytic therapy was carried out. The clinical results were analyzed. Results The technical success rate was 100%. Patients complained of
出处
《介入放射学杂志》
CSCD
北大核心
2013年第7期582-586,共5页
Journal of Interventional Radiology
关键词
深静脉血栓形成
下肢
取栓
介入性
deep venous thrombosis
lower extremity
thrombectomy,interventional
