急性髂股静脉血栓形成的介入治疗

Interventional therapy for acute iliofemoral venous thrombosis

目的探讨介入技术在急性髂股静脉血栓治疗中的应用价值。方法回顾性分析2006年1月至2009年10月我院32例急性髂股静脉血栓形成患者综合介入治疗的临床资料。采用彩色超声多普勒引导下经胭静脉穿刺置管溶栓联合髂静脉支架植入治疗，静脉造影评价静脉通畅程度。结果32例均行临时性下腔静脉滤器植入术，在彩色超声多普勒引导下经胭静脉穿刺置管溶栓；27例行球囊扩张及髂静脉支架植入术，放置支架29枚，其余5例单纯行球囊扩张术；术后患肢临床症状明显减轻或消失，未出现肺动脉栓塞，经胭静脉溶栓后经导管静脉造影见髂静脉再通率为40％-90％，平均60％，股静脉再通率为50％～80％，平均70％，32例随访2—45个月，平均16个月，27例髂静脉支架植入髂静脉通畅率为100％，5例行球囊扩张术患者中，1例髂静脉完全闭塞，4例髂静脉再通率为20％～30％。结论经胭静脉置管溶栓联合髂静脉支架植入术是治疗急性髂股静脉血栓的有效方法，创伤小、恢复快、安全、疗效肯定。

Objective To evaluate intervention management in the treatment of acute iliofemoral venous thrombosis. Methods The clinical data of 32 patients with acute iliofemoral venous thrombosis who were admitted to our hospital from January 2006 to October 2009 were analyzed retrospectively. Under the guidance of ultrasonography, intravenous thrombolysis through the popliteal vein combined with iliac vein stenting was employed. The venous patency was assessed with angiography. Results The implantation of a temporary cava filter was required in all patients who received intravenous thrombolysis through the popliteal vein under the guidance of ultrasonograpby. Balloon dilatation angioplasty combined with endovascular stenting was applied in 27 patients. Balloon dilatation angioplasty alone was utilized in other 5 patients. Clinical symptoms present in the affected limb significantly subsided or completely disap- peared in these patients after the combined interventional therapy. No symptomatic embolism of pulmonary artery was developed. After intravenous thrombolysis through the popliteal vein, the recanalization rate was 40% -90% （mean ：60% ）in the iliac vein and 40% ~ 90% （mean ：70% ）in the femoral vein. Fellow - up observation for 2 -45 months （mean：16 mouths）were carried out in all patients. The pateney rate was 100% in 27 patients receiving iliac vein stenting. Out of 5 patients who were only subjected to iliac balloon dilatation,the iliac vein was completely obstructed in 1 patient and was recanalized by 20% ~ 30% in 4 patients. Conclusion Catheter - based thrombolysis through the popliteal vein combined with endovascular stenting is effective for the treatment of acute iliofemoral venous thrombosis, and possesses the advantages of less trauma, quick recovery, safety and long - term efficacy.