急性下肢静脉血栓处理策略

Treatment strategies of acute lower-extremity venous thrombosis

急性下肢静脉血栓是血管外科最常见的静脉急症,发病率较高。如处理得当,血栓急性期脱落会造成肺栓塞,部分慢性期病人合并血栓复发、血栓后综合征等并发症,严重影响病人生活质量。因此,明确下肢静脉血栓的危险因素,对于高龄、制动、手术、创伤、产后、恶性肿瘤等病人提高警惕,进行合理预防与评估,降低院内血栓的发生率。一旦血栓形成,如无抗凝禁忌,立即行抗凝治疗,出血风险评估后,选择合适的腔内治疗手段,如导管接触性溶栓或经皮机械血栓清除术。对于合并髂静脉狭窄或闭塞的病人,可行支架植入术。对于抗凝禁忌或下腔静脉漂浮血栓的病人,可行腔静脉滤器植入术。院内层面血栓防控体系的建立,有利于对血栓病人早发现、早诊断、早治疗,意义深远。

Acute venous thrombosis of the lower extremities is the most common venous emergency in vascular surgery with a high incidence.If it isn’t handled properly,thrombus shedding in the acute phase will cause pulmonary embolism,and some patients in the chronic phase will have complications such as thrombosis recurrence and postthrombotic syndrome,which will seriously affect the quality of life of the patients.Therefore,clarifying the risk factors and being vigilant for patients with venerable age,immobilization,surgery,trauma,postpartum,and malignant tumors,carrying on reasonable prevention and evaluation should be performed to reduce the incidence of thrombosis in the hospital.Once thrombosis is formed,if there is no contraindication to anticoagulation,anticoagulation therapy should be performed immediately.After the bleeding risk is assessed,select appropriate endovascular treatment methods,such as catheter directed thrombolysis or percutaneous mechanical thrombectomy.For patients with iliac vein stenosis or occlusion,stent implantation is feasible.For patients with contraindications to anticoagulation or floating thrombosis in the inferior vena cava,implantation of the vena cava filter is feasible.The establishment of a thrombosis prevention and control system at the hospital level can provide early detection,early diagnosis and early treatment of thrombosis patients.