导管溶栓加腔内成形治疗下肢深静脉血栓

Catheter-directed thrombolysis with endovascular angioplasty for acute deep vein thrombosis

目的研究导管直接溶栓加腔内成形治疗下肢深静脉血栓(DVT)的疗效。方法82例深静脉栓塞(DVT)患者采用导管直接溶栓加腔内成形治疗。左下肢DVT66例,右下肢DVT16例,髂股静脉血栓48例,全肢静脉血栓34例;病程2～10d。结果所有患者在髂总静脉成形术前置入下腔静脉滤器,术后造影示滤器血栓捕获率为7.32%。导管溶栓术后患肢胀痛和水肿消失。66例左下肢DVT患者行髂总静脉球囊扩张后,狭窄完全消失8例,部分消失58例。溶栓后深静脉造影示溶栓Ⅲ级62例(75.61%),Ⅱ级20例(24.39%)。髂总静脉完全通畅40例,狭窄<50%32例,>50%10例,髂总静脉支撑植入10例。术后1～36个月随访,深静脉完全通畅72例。其中,深静脉瓣膜功能良好66例,返流6例,深静脉阻塞10例。其中,症状复发2例,血栓后综合征4例,无症状4例。结论导管溶栓加腔内成形术是治疗DVT的有效方法。

Objective To evaluate the outcomes of catheter-directed thrombolysis with endovascular angioplasty in treating acute deep vein thrombosis （DVT）. Methods Eighty-two patients with DVT were treated with catheter-directed thrombolysis and endovascular angioplasty. DVT of 66 patients was in the left lower extremity, of 16 patients in the right lower extremity,of 48 patients in the iliofemoral vein, and of 34 patients in the ilio-femoral-popliteal vein. Results A filter was placed in the inferior vena cava（IVC） in all cases. A large piece of thrombosis was arrested by filter in 7.32% cases with DVT after endovascular angioplasty. The acute symptoms of DVT such as pain and swelling resolved more quickly and completely after the treatment. The balloon angioplasty was performed in 66 patients with occlusion in the left common iliac vein. The stenosis in the left common iliac vein was disappeared completely in 8 cases and partially in 58 cases after balloon angioplasty. According to lysis grade by the venograms, grade Ⅲ lysis achieved in 62 cases （75.61%）and grade Ⅱ in 20 cases （24.39%）. The patency, stenosis less than 50% and stenosis more than 50% of common iliac vein were in 40, 32 and 10 cases,respectively. Stent was placed in 10 patients with occlusion of the left common iliac vein after catheter-directed thrombolysis. During follow-up of 1 to 36 months with Doppler, the patency of deep vein was observed in 72 cases, of whom venous valve function remained normal in 66 cases and reflux of venous valve occurred in 6 cases, and the occlusion of deep vein in 10 cases. There were 4 cases with post-thrombosis syndrome, 2 cases with symptoms and 4 cases without symptoms . Conclusion Catheter-directed thrombolysis with endovascular angioplasty is safe, simple and effective in treating acute DVT.