双侧股静脉入路在左下肢深静脉血栓介入治疗中的应用

The application of bilateral femoral vein approaches in interventional treatment of deep venous thrombosis of left lower extremity

目的探讨采用双侧股静脉入路介入插管溶栓方法治疗左下肢深静脉血栓的可行性。方法对18例从右股静脉或右颈静脉入路行左髂股静脉插管失败的急性左下肢深静脉血栓患者,采用左侧股静脉顺行法穿刺,注射对比剂证实穿刺成功后将导丝插入至下腔静脉,将导丝从右侧股静脉或颈静脉穿出或拉出后建立导丝轨道,再沿导丝将导管自右向左逆行插入左侧髂股静脉留置溶栓。结果 18例左股静脉穿刺16例获得成功,建立了左右股静脉导丝轨道,并顺利将导管自右股静脉或颈静脉插入左侧髂股静内;经过3～14 d导管溶栓后血栓均完全溶解,下肢肿胀消退;在溶栓过程中左侧股静脉穿刺处无明显淤血和血肿发生。结论对于经右股静脉或右颈静脉入路插管失败的左下肢深静脉血栓形成者,采用双侧股静脉入路建立导丝轨道后再插管的方法,成功率高、安全、创伤小,临床应用可行。

Objective To investigate the feasibility of interventional catheterization with bilateral femoral vein approaches for performing the thrombolytic treatment of acute deep venous thrombosis of left lower extremity.Methods Antegrade puncturing into the left femoral vein was carried out in eighteen patients with acute deep vein thrombosis in the left lower extremity after left iliac-femoral vein catheterization via the right femoral vein or the right jugular vein access failed.When the puncturing of the left femoral vein was successfully done and was confirmed by angiography,the guide wire was inserted into the inferior vena cava and was pulled out through the right femoral vein or right jugular vein,and a wire track was thus established.Then,retrograde insertion of the catheter was conducted along the wire from the right to the left until the catheter was placed into the left iliac-femoral vein for thrombolysis.Results Of 18 cases,successful puncturing into the left femoral vein was achieved in 16,and an effective wire track was established between the left and right femoral veins,based on which the catheter was smoothly inserted into the left iliac-femoral vein via the right femoral vein or jugular vein.Catheter thrombolysis was employed for 3 to 14 days,the thrombus was completely dissolved and the lower extremity swelling subsided.During the course of thrombolysis,no obvious congestion or hematoma occurred at the puncturing site of the left femoral vein.Conclusion For patients with deep vein thrombosis of left lower extremity,when left iliac-femoral vein catheterization via the right femoral vein or the right jugular vein access failed,the establishment of wire track by using bilateral femoral vein approaches for further catheterization of left iliac-femoral vein and subsequent thrombolysis is feasible in clinical practice.This technique is safe and minimally-invasive with higher success rate.