摘要
目的探讨累及下腔静脉血栓形成的危险因素及腔内血栓清除术的治疗效果。方法回顾性收集上海交通大学医学院附属第九人民医院2019年1月至2020年12月行腔内血栓清除术治疗的461例急性下肢静脉血栓形成患者的临床资料,其中累及下腔静脉患者33例,通过多因素分析血栓形成累及下腔静脉的危险因素,根据危险因素采用倾向性评分匹配方法,按照1∶1匹配的方式比较累及下腔静脉(累及组)和未累及下腔静脉(对照组)患者腔内治疗手术相关结果。结果多因素分析显示,恶性肿瘤(OR=2.851,95%CI=1.145~9.097)、家族史(OR=3.689,95%CI=1.405~9.688)、双下肢深静脉血栓形成(OR=4.251,95%CI=1.626~11.117)、滤器置入(OR=3.795,95%CI=1.411~10.210)是血栓形成累及下腔静脉的独立危险因素。患者经1∶1匹配后,累及组需要置管溶栓比例更高(60.6%vs 6.5%,P<0.001),但支架植入率更低(48.5%vs 71.0%,P=0.021);两组患者合并无症状肺栓塞率(15.2%vs 9.7%)、穿刺点并发症率(18.2%vs 12.9%)、术后深静脉血栓形成后综合征发生率(21.2%vs 19.4%)差异均无统计学意义(P>0.05)。结论有恶性肿瘤、下腔静脉滤器和家族性易栓症的下肢深静脉血栓形成患者应尽早给予规范抗凝治疗。血栓形成累及下腔静脉并不影响腔内血栓清除术治疗的有效性和安全性。
Objective To investigate the risk factors and endovascular therapy for iliofemoral venous thrombosis involving inferior vena cava (IVC). Methods The clinical data of 461 patients with acute deep vein thrombosis (DVT) of the lower extremities t underwent endovascular thrombectomy from January 2019 to December 2020 in the Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine were retrospectively collected, including 33 patients with DVT involving the IVC. The risk factors of DVT involving the IVC were analyzed by multivariate analysis. The propensity score matching method was used according to the risk factors, and endovascular treatment-related outcomes were compared in a 1∶1 matching manner between patients involving IVC (IVC group) and not involving IVC (control group). Results Multivariate analysis showed that malignant tumor (OR=2.851, 95%CI=1.145-9.097), family history (OR=3.689, 95%CI=1.405-9.688), bilateral DVT (OR=4.251, 95%CI=1.626-11.117), and filter placement (OR=3.795, 95%CI=1.411-10.210) were risk factors for thrombosis involving IVC. After 1∶1 matching of patients, the IVC group had a higher proportion of thrombolysis required by catheter-directed thrombolysis (60.6% vs 6.5%, P<0.001), but a lower rate of stent implantation (48.5% vs 71.0%, P=0.021). There was no significant difference in the incidence of asymptomatic pulmonary embolism (15.2% vs 9.7%), puncture site complication rate (18.2% vs 12.9%), and postoperative deep vein thrombosis syndrome (21.2% vs 19.4%) between the IVC group and control group (P>0.05). Conclusion Patients with DVT with malignant tumor, IVC filter and familial thrombophilia should be given standardized anticoagulation therapy as soon as possible. Thrombosis involving the IVC does not affect the efficacy and safety of endovascular therapy.
作者
仇鹏
彭智猷
殷敏毅
李维敏
陆信武
叶开创
Qiu Peng;Peng Zhiyou;Yin Minyi;Li Weimin;Lu Xinwu;Ye Kaichuang(Department of Vascular Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University,School of Medicine,Vascular Center of Shanghai Jiao Tong University,Shanghai 200011,China)
出处
《中国血管外科杂志（电子版）》
2022年第3期205-208,212,共5页
Chinese Journal of Vascular Surgery(Electronic Version)
基金
上海市科学技术委员会医学引导类项目(19411966100)。
关键词
深静脉血栓形成
髂股静脉
下腔静脉
危险因素
腔内治疗
Deep venous thrombosis
Iliofemoral vein
Inferior vena cava
Risk factors
Endovascular therapy
