急性下肢深静脉血栓的介入治疗

Interventional Treatment for the Patients with Acute Deep Venous Thrombosis of Lower Limbs

目的 探讨急性下肢深静脉血栓介入治疗的临床疗效.方法 2010年9月至2012年11月对55例急性下肢深静脉血栓患者采用下腔静脉滤器保护下腘静脉置管溶栓治疗,合并Cockett综合征者溶栓后行介入治疗,随访观察疗效.结果 54例行导管溶栓后复查造影,33例血栓完全溶解(57.4%);18例血栓基本完全溶解,再通率大于90%(33.3%);4例血栓大部分溶解,再通率大于50%(7.4%).发现21例左髂静脉重度狭窄或闭塞,3例单纯行球囊扩张,17例行球囊扩张及支架置入术,1例导丝未通过闭塞段.随访时间1～24月(平均15个月),无血栓复发病例,单纯行球囊扩张的3例患者术后狭窄复发,17例髂静脉支架通畅率100%.结论 下腔静脉滤器保护下腘静脉置管溶栓治疗能有效溶解血栓,并有效预防肺栓塞发生.髂静脉支架植入是治疗Cockett综合征的有效方法.

Objective To discuss the clinical effect of interventional treatment for the patients with acute deep venous thrombosis of lower limbs.Methods We treated 55 patients with acute deep venous thrombosis of lower limbs whom underwent catheter of popliteal vein thrombolysis under protection of vena cava filter,the patients complicated by Cockett syndrome underwent interventional treatment after thrombolysis from September 2010 to November 2012.All patients were observed and followed-up.Results Fifty four patients underwent venography after catheter directed thrombolysis.The results of venography showed that thrombosis was absolutely dissolved in 33 patients,thrombosis approximately absolutely dissolved in 18 patients with the thrombus recanalization rate of over 90%and thrombosis was most dissolved in 4 patients with the thrombus recanalization rate of over 50%.Twenty one patients have serious stenosis or occlusion in left iliac vein by means of venography.Three patients underwent balloon dilatation angioplasty and 17 did balloon dilatation angioplasty combined with endovascular stenting,of which 1was failed because the guide wire could not pass the occlusion.The time of followed-up was from 1 to 24months with an average of 15 months and there was no recurrence in thrombosis.Three patients treated with balloon dilatation angioplasty have a relapse of stenosis.The patency rate of stent in 17 cases of iliac vein was100%.Conclusions Catheter of popliteal vein thrombolysis under protection of vena cava filter could effectively dissolve thrombosis and could also effectively prevent pulmonary embolism.The iliac vein endovascular stenting is a kind of effective therapeutic strategy for the patient with Cockett syndrome,