腔内治疗髂静脉梗阻合并急性深静脉血栓的临床经验

Endovascular Stenting for Iliac Venous Occlusion Complicated with Acute Deep Vein Thrombosis

目的探讨腔内治疗髂静脉梗阻合并急性深静脉血栓(deep vein thrombosis,DVT)的临床效果。方法 2008年10月～2011年9月,19例急性DVT接受手术取栓联合同侧髂静脉腔内支架置入术。DVT位于左髂-股静脉及下腔静脉3例,双侧髂-股静脉2例,其余14例均在左髂静脉。均有患肢明显肿胀,其中12例伴患肢疼痛。DVT发病时间(3.2±1.3)d。取栓前均先置入下腔静脉滤器,取栓后即刻静脉造影发现髂静脉狭窄者先行球囊扩张再置入自膨式支架。结果 18例取栓后造影示髂静脉狭窄,其中髂静脉压迫综合征(iliac vein compression syndrome,IVCS)15例(78.9%),残留狭窄3例;1例未发现髂静脉狭窄。18例有狭窄者共置入22枚自膨式支架,手术均获成功。1例术后伤口血肿。随访16例,随访时间2～26个月(平均10.3月),疼痛症状均消失,2例行走后下肢轻度肿胀,均未出现血栓复发。结论腔内治疗髂静脉梗阻合并急性DVT安全、有效,早期临床结果满意。

Objective To evaluate the clinical outcomes of stenting for iliac venous occlusion complicated with acute deep vein thrombosis（DVT）.Methods From October 2008 to September 2011,a total of 19 patients with acute DVT underwent thrombectomy combined with endovascular stenting in the ipsilateral iliac vein at our hospital.The DVT was detected in the femoro-ilio-caval vein in 3 cases,bilateral ilio-femoral vein in 2 cases,and left iliac vein in 14 cases.All the patients had leg swelling and 12 of them had severe limb pain.The mean course of DVT was（3.2±1.3） days.An inferior vena cava filter was inserted before thrombectomy,those whose venography showed iliac vein stenosis received balloon dilatation and a self-expandable stent immediately.Results Intraoperative venography showed severe venous stenosis in 18 patients including 15（15/18 78.9%） iliac vein compression syndrome ICVS） and 3 cases of residual stenosis.Total 22 self-expandable stents were inserted successfully（success rate： 100%）,one of them suffered from incisional hematoma after the operation.We lost three patients to follow-up,the other 16 patients were followed up for 2 to 26 months with a mean of 10.3 months.All of them had the pain disappeared,two patients showed slight leg swelling,and no recurrent thrombosis were recovered.Conclusion Endovascular Stenting is safe for iliac venous occlusion complicated with acute DVT with a satisfying early-stage outcome.