摘要
目的初步探讨采用综合介入技术一体化治疗急性下肢深静脉血栓形成的可行性、安全性和有效性。
方法2016年6月至2017年6月，我科行AngioJet血栓清除术为主的综合介入一体化方案治疗23例急性单侧下肢深静脉血栓形成（DVT）患者，对其临床资料进行回顾性分析。AngioJet血栓清除术，球囊扩张和髂静脉支架植入均在一次手术中完成。术后即刻复查造影，若血栓清除率Ⅲ级且下肢深静脉与下腔静脉无大块游离血栓（最大径〉5 mm），则经原滤器输送鞘回收滤器；若血栓清除率为Ⅰ、Ⅱ级，或下肢深静脉、下腔静脉内有游离血栓则解脱滤器，术后所有患者保留鞘管持续溶栓。术后第1、3、6、12个月进行门诊随访，行彩超和（或）下肢静脉造影检查了解下肢深静脉及髂静脉支架内血流通畅情况。
结果血栓清除率Ⅲ级者20例（87%），均成功完成综合介入一体化治疗；血栓清除率Ⅱ级者3例（13%），解脱滤器，并经溶栓治疗后顺利取出。21例患者合并髂静脉狭窄，同期植入髂静脉支架21枚。所有患者未发生出血、症状性肺栓塞等严重并发症。术后随访所有患者，经超声和（或）下肢静脉造影检查提示下肢深静脉及髂静脉支架内血流通畅。
结论采用综合介入技术一体化治疗急性下肢DVT是一种安全有效的方法。
ObjectiveTo evaluate the feasibility, safety and effectiveness of integrated treatment with comprehensively interventional techniques for acute deep venous thrombosis （DVT） of lower extremity.
MethodsDuring the period from June 2016 to June 2017, a total of 23 patients with acute DVT of unilateral lower extremity were admitted to authors＇ hospital to receive integrated treatment. AngioJet thrombectomy, balloon angioplasty and iliac vein stent implantation were performed in the same setting. Angiography was performed immediately after the procedure. If the thrombus clearance rate was grade Ⅲ and there were no large free clots （〉5mm） in the lower extremity vein and inferior vena cava, the inferior vena cava filters would be retrieved through their sheath, otherwise, the inferior vena cava filters would be released. All patients received continuous transcatheter infusion of urokinase until the thrombosis was confirmed to be completely dissolved. The patients were followed up at outpatient clinic at 1, 3, 6 and 12 months after the treatment, and reexamination of color ultrasound and/or lower limb venography was used to assess the blood flow in the deep veins and in the stents.
ResultsAngiography postoperatively showed thrombus clearance rate of grade Ⅲ was obtained in 20 patients （87%） who were successfully accomplished integrated treatment. The inferior vena cava filters had been retrieved after thrombolysis in 3 patients （13%） with thrombus clearance rate of grade Ⅱ. Twenty-one stents were implanted directly after thrombectomy in 21 patients with iliac vein stenosis. There were no serious complications such as pulmonary embolism, severe hemorrhage, etc. Venous patency was confirmed by color ultrasound or lower limb venography.
ConclusionIntegrated treatment with comprehensively interventional techniques is feasible, safe, and effective for acute DVT of lower extremity.
作者
印于
金泳海
段鹏飞
樊宝瑞
杨超
张帅
杜鹏
倪才方
Yin Yu;Jin Yonghai;Duan Penfei;Fan Baorui;Yang Chao;Zhang Shuai;Du Peng;Ni Caifang(Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2018年第6期463-466,共4页
Chinese Journal of Radiology
关键词
静脉血栓形成
下肢
栓塞和血栓形成
血栓溶解疗法
综合介入治疗
Venous thrombosis
Lower extremity
Embolism and thrombosis
Thrombolytic therapy
Comprehensive interventional treatment
