置管溶栓术治疗下腔静脉滤器内栓子的疗效观察

Catheter-directed thrombolysis for embolus trapped by the inferior vena cava filter

目的评价置管溶栓术治疗下腔静脉滤器内栓子的疗效及安全性。方法 2005年1月至2010年12月对31例经造影证实的下腔静脉滤器内存在栓子患者进行置管溶栓术治疗,栓子最大径均超过1 cm,溶栓药物采用尿激酶,用量为每日60万u,疗程为3～7 d,术后观察临床疗效及并发症。结果经置管溶栓治疗,18例栓子消失,7例栓子最大径缩小至3 mm以下,6例无明显变化。并发症有穿刺点渗血5例,血尿3例,腹膜后血肿1例,无严重并发症发生。并发症经对症治疗恢复良好。25枚滤器被成功取出,6枚滤器被留置。滤器取出术中及术后无急性肺栓塞发生。结论置管溶栓术是治疗下腔静脉滤器内栓子安全、有效的方法,能提高下腔静脉滤器的取出率。

Objective To evaluate the clinical results of catheter-directed thrombolysis in treating embolus trapped by the inferior vena cava filter. Methods During the period from Jan. 2005 to Dec. 2010, a total of 31 cases with angiography-proved embolus trapped by the inferior vena cava filter received catheter- directed thrombolysis at the hospital. The maximum diameter of all the emboli was over one cm. Intravenous infusion of 600 KU urokinase （used as thrombolytic agent） daily via a pigtail catheter, which w^s place in the inferior vena cava distal to the filter, was carried out. Every 3 - 7 sessions constituted a therapeutic course. After the treatment, observation for the clinical efficacy and the complications was taken. The results were analyzed. Results After the catheter-directed thrombolysis, 18 emboli disappeared and 7 emboli were reduced in size with the maximum diameter shrinking to less than 3 mm. No obvious change in embolus size was seen in 6 patients. Complications included oozing of blood at puncture point（n = 5）, hematuria （n = 3） and retroperitoneal hematoma （n = 1）. After symptomatic medication, the clinical condition restored to normal. No other severe complications occurred. Successful retrieval of the filters was obtained in 25 patients, and 6 filters were retained. No acute pulmonary embolism occurred during and after the procedure of filter retrieval manipulation. Conclusion Catheter- directed thrombolysis is a safe and effective treatment for embolus trapped by the inferior vena cava filter, and this technique can improve the retrieval rate of the filter. （J Intervent Radiol, 2013, 22： 027-030）