经腘静脉综合介入治疗下肢深静脉血栓形成

Transpopliteal vein interventional treatment for lower extremity deep venous thrombosis

目的探讨经膳静脉穿刺血栓抽吸及接触性溶栓治疗下肢深静脉血栓的临床应用价值。方法对30例下肢深静脉血栓形成患者采用经患侧胭静脉入路综合性介入治疗，在行下腔静脉滤器植入前提下，先行球囊扩张机械性破碎血栓及IOF改良下腔静脉支架输送鞘行血栓抽吸，然后行接触性溶栓治疗，4例患者于溶栓后行骼静脉支架植入术治疗，以静脉通畅评分和静脉通畅率及健、患肢周径差等指标评价疗效，患者随访1年以上。结果技术成功率为100％，30例患者于治疗6个月复诊，双下肢周径差〈1．5cm，行下肢静脉造影复查，静脉通畅评分显著改善[治疗前后分别为（9．5±2．6）、（3．6±2．1分），Z=1．65，P〈0．01]，静脉通畅率为（69．5±13．2）％。治疗过程中未出现严重并发症。结论经胭静脉综合介入治疗下肢深静脉血栓安全有效、操作简便。

Objective To evaluate the clinical value of the pumping and popliteal vein thrombosis contact thrombolytic treatment of lower extremity deep venous thrombosis （LEDVT）. Methods For thirty deep venous thrombosis patients with ipsilateral popliteal vein approach through a comprehensive intervention, the line of the inferior vena cava filter was implanted under the premise of first balloon mechanical thrombus fragmentation and thrombus aspiration by 10 F improved the inferior vena cava stents conveying sheath,followed by the line of contact thrombolytic therapy. Four patients underwent iliac vein in the thrombolytic treatment of stent implantation. Vein pateney and venous patency score and health and poor limb circumference difference were used to assess efficacy of treatment. Patients were followed up for at least 1 year. Results The technical success rate was 100%. At six months after sugery, the mean lower limb circumference difference of the 30 patients was 〈 1.5 cm. Lower limb venous angiography showed significantly improved vein patency score [ （9.5±2. 6） vs. （3.6 ±2. 1 ）, Z = 1.65, P 〈 0. 01 ]. Venous patency rate was （69. 5 ± 13.2） %. No serious complications during treatment and the period of follow-up. Conclusion Transpopliteal vein interventional treatment of lower extremity deep venous thrombosis is simple, safe and effective.