球囊扩张辅助经导管直接溶栓导致下腔静脉滤器栓塞及其处理

Inferior vena cava filter embolism caused by balloon-assisted catheter-directed thrombolysis and its treatment

目的探讨球囊扩张辅助经导管直接溶栓(CDT)治疗急性下肢深静脉血栓形成(DVT)过程中下腔静脉滤器(VCF)血栓阻塞的发生率及其处理。方法 2009年9月至201 1年5月收治44例急性下肢DVT患者,作下腔静脉VCF保护下行球囊扩张辅助CDT治疗。结果 27.3%(12/44)患者因VCF拦截大量血栓导致下腔静脉阻塞(完全闭塞8例,部分闭塞4例),经CDT治疗后1 1例完全通畅,1例部分通畅(造影表现为VCF远端充盈缺损)。治疗前后下腔静脉通畅度评分差异有统计学意义(X^2=48.2,P=0.000)。88.64%(39/44)的患者放置可取出VCF,治疗结束后均全部顺利取出。主要并发症包括穿刺点出血13.6%(6/44)、肉限血尿4.5%(2/44)、痰中带血4.5%(2/44),未发生症状性肺栓塞。结论球囊扩张辅助CDT治疗急性下肢DVT可能发生血栓脱落,由此导致的急性VCF血栓阻塞经CDT治疗效果良好。

Objective To investigate the occurrence of inferior vena cava filter obstruction which is caused by balloon-assisted catheter-directed thrombolysis （CDT） for acute lower extremity deep vein thrombosis （DVT）, and to discuss the treatment of this complication. Methods During the period from September 2009 to May 2011, 44 patients with acute DVT of lower extremity were admitted to authors hospital. Balloonassisted CDT with the protection of inferior vena cava filter （VCF） was carried out in all patients. The results were analyzed. Results Acute inferior vena cava （IVC） obstruction due to large amount of thrombus captured by VCF was found in 27.3% of the patients （12/44）, including complete occlusion （n = 8） and partial occlusion （n = 4）. After CDT treatment, complete patency of IVC was obtained in ll patients and partial patency of IVC in one patient. The degree of IVC patency after CDT was significantly different from that before CDT （X2 = 48.2, P = 0.000）. Retrievable VCF was placed in 88.64% of the patients （39/44）, and all the VCFs were successfully taken out when the therapy was finished. The main complications included puncture site bleeding （13.6%, 6/44）, gross hematuria （4.5%, 2/44） and bloody sputum （4.5%, 2/44）. No symptomatic pulmonary embolism occurred in the whole procedural course. Conclusion Thrombus migration is a common phenomenon occurred during balloon- assisted CDT for lower extremity DVT, leading to acute inferior vena cava filter obstruction. Catheter-directed thrombolysis is very effective for the treatment of acute inferior vena cava filter obstruction.（J Intervent Radiol, 2012, 21 ： 461-464）