可回收支架治疗下腔静脉阻塞合并血栓形成的中期疗效

Retrievable stent filter placement for the treatment of Budd-Chiari syndrome complicated with inferior vena cava thrombosis: its mid-term results

目的观察可回收支架治疗下腔静脉阻塞(BCS)合并血栓形成的中期疗效。方法8例下腔静脉合并血栓BCS,采用术中抗凝溶栓治疗后,行钝性破膜小球囊预扩张后植入可回收支架,最后使用大球囊充分扩张闭塞膜。术后给予抗凝溶栓治疗,待血栓消失后经颈内静脉将可回收支架取出。其中下腔静脉节段性闭塞合并血栓患者同时置入"Z"型支架。术后用彩色多普勒随访疗效。结果8例患者均成功实施了介入治疗,血栓均在短期内消失,可回收支架顺利取出,术中未发生肺动脉栓塞和其他并发症。彩色多普勒超声随访3～12个月,2例下腔静脉狭窄,余6例可回收支架置入部位未见血栓形成、局部再狭窄及管壁增厚等情况发生。结论使用可回收支架治疗下腔静脉阻塞合并血栓形成疗效满意。

Objective To investigate the mid-term efficacy of retrievable stent filter placement for the treatment of Budd-Chiari syndrome （BCS） complicated with inferior vena eava （IVC） thrombosis. Methods Eight patients of BCS complicated with IVC thrombosis were enrolled in this study. IVC thrombosis included segmental occlusion （n = 2） and membranous occlusion （n = 6）. In all patients, the IVC was re-canalized by using blunt wire after antieoagulation and thrombolytic therapy, then, the re-canalized site was expanded with small balloon, which was followed by the placement of retrievable stent filter, and, finally, IVC size was dilated with larger balloon. Antieoagulation and thrombolytic therapy was given after the procedure. And all the retrievable stent filters were withdrawn from the IVC through internal jugular vein when the thrombus in IVC was dissolved. In patients with segmental occlusion of IVC, in addition to the placement of retrievable stent filter a ＂Z＂ type vessel stent was also placed during the same interventional session. Follow-up examination with color Doppler sonography was conducted in all patients. Results Technical success was achieved in all 8 patients without pulmonary infarction or other complications both during and after the operation. Immediately after the thrombus completely disappeared, the retrievable stent filter was successfully taken out in all patients. During a following-up period of 3-12 months, color Doppler sonographs showed that the IVC remained patent in 6 patients and had a recurrence of stenosis in 2 patients. Conclusion Placement of retrievable stent filter is a safe and effective treatment for BCS complicated with IVC thrombosis.