下腔静脉滤器置入后介入治疗急性髂股静脉血栓的临床应用

THE CLINICAL APPLICATION OF INTERVENTIONAL THERAPY OF ACUTE ILIOFEMORAL VENOUS THROMBOSIS AFTER INFERIOR VENA CAVA FILTER PLACEMENT

目的探讨下腔静脉滤器置入后,经腘静脉置管溶栓治疗急性髂股静脉血栓的临床应用价值。方法 17例急性髂股静脉血栓患者均经血管超声及造影证实,均在置入下腔静脉滤器后,在B超引导下行经腘静脉置入溶栓导管,采用抗凝及经溶栓导管脉冲式灌注尿激酶治疗,其中行左髂总静脉球囊扩张术4例。结果溶栓导管平均放置时间为(5±2)d。17只下腔静脉滤器展开良好,无移位。阻塞血管完全开通13例,部分开通4例,溶栓治疗过程中未出现肺动脉栓塞症状及出血现象。结论在下腔静脉滤器置入后经腘静脉置管溶栓治疗急性髂股静脉血栓是一种安全、有效的方法。

Objective To discuss the feasibility of catheter directed thrombolysis for acute iliofemoral venous thrombosis after inferior vena cava filter placement. Methods Seventeen patients with acute iliofemoral venous thrombus were enrolled in the study, whose diagnosis were confirmed by sonography and angiography. All the patients with acute iliofemoral venous thrombosis underwent infusion catheter directed thrombolysis with urokinase and anti - coagulation, among which 4 cases were treated with balloon dilatation in left common iliac vein after insertion of inferior vena cava filter. Results The average time of infusion catheter placement was （5 ＋ 2） days. A total of 17 inferior vena cava filters were successfully deployed without disposition and migration; Complete thrombolysis was obtained in 13 cases （76. 5% ） and partial thrombolysis in 4 cases （23. 5% ） respectively. No pulmonary embolism and hemorrhage occurred during the procedure of thrombolysis. Conclusion It is a safe and effective method in the thrombolysis therapy by catheter directed thrombolysis for acute iliofemoral venous thrombosis after preventive placement of inferior vena cava filter.