下腔静脉CO_2-DSA的临床应用

The clinical application of inferior vena caval CO2-DSA

目的探索下腔静脉CO_2-DSA的可行性和安全性;评价碘剂和CO_2两种对比剂下腔静脉造影结果。方法已明确下肢深静脉血栓并准备行滤器植入患者25例;所有病例在滤器植入前均采用经颈静脉或股静脉入路行下腔静脉及右肾静脉碘剂和CO_2-DSA检查。结果所有病例下腔静脉CO_2-DSA及碘剂造影均获得成功。下腔静脉造影图像质量:采用CO_2-DSA方法,14例优,11例良;采用碘剂-DSA方法,18例优,7例良。两种造影方法未发现下腔静脉内血栓形成及腔静脉变异病例。下腔静脉直径测量:CO_2-DSA为(20.01±0.83)mm;碘剂-DSA为(20.15±0.92)mm,(P=0.006),两者间差异有统计学意义。下腔静脉CO_2-DSA的安全性:25例患者仅1例出现一过性血氧饱和度轻度下降,但血压、心率等指标未见异常改变。结论下腔静脉CO_2-DSA是可行的、安全的;下腔静脉CO_2-DSA与碘剂比较在腔静脉直径测量上虽有统计学意义,但不会影响临床滤器的安全植入;

Objective To explore the feasibility and safety of inferior vena caval CO2-DSA and evaluate the results of inferior vena cavography using CO2-DSA or iodinated contrast media. Methods 25 patients diagnosed as deep venous thrombosis of lower limb were prepared to conceive the implantation of inferior vena caval filter. The inferior vena cava and right renal vein CO2-DSA and iodinated contrast media DSA were carried out through jugular or femoral vein approach in all patients. Results The inferior vena caval angiography with CO2-DSA or iodinated contrast media were carried out successfully in all patients. The quality of the inferior vena caval angiogram showed： with CO2 as contrast media, 14 cases obtained excellent images and 11 cases had good images; with iodinated contrast media the images of 18 cases were excellent and 7 cases were good. No thrombus and variation of inferior vena cava were found by the two kinds of angiography. The diameter of inferior vena cava showed： （20.01 ± 0.83） mm with CO2 contrast media and （20.15 ± 0.92） mm with iodinated contrast media, （P = 0.006）;having statistical significance between them. The safety of angiography with CO2 presented only 1 case with transient slight decrease of O2 saturation. No abnormal changes were found in blood pressure, heart rate and so on. Conclusions Inferior vena caval CO2-DSA is feasible and safe, with statistical significance in the measurement of inferior vena caval diameter comparing with iodinated contrast material but with no influence on the implantation of filter.