混合型下肢深静脉血栓综合介入治疗的并发症及其对策

Integrated interventional treatment for mixed type of lower extremity deep vein thrombosis: complications and management

目的：探讨混合型下肢深静脉血栓（LEDVT）综合介入治疗的并发症及治疗对策。方法：回顾性分析7年间采用综合介入治疗的488例急性或亚急性混合型DVT患者的临床资料。所有患者先行下腔静脉滤器植入,再行机械性血栓碎吸、导管溶栓、抗凝等治疗;如合并症状性肺栓塞,则行肺动脉导管溶栓治疗;如合并髂静脉狭窄或闭塞同时行球囊扩张血管成形术（PTA）或支架植入治疗。结果：症状性肺栓塞发生率为7.58%（37/488）,2例（2/37）抢救无效死亡。综合介入治疗中血管损伤发生率为9.22%（45/488）,滤器拦截大块血栓的发生率为16.60%（81/488）。术后抗凝过程中发生异常出血率5.53%（27/488）,2例患者因脑出血死亡。451例患者获随访4-94（平均41）个月,血栓后综合征（PTS）发生率11.53%（52/451）;PTA后出现静脉再堵塞发生率为40.19%（43/107）;支架植入后静脉再堵塞发生率为6.6%（7/106）。结论：综合介入疗法治疗混合型下LEDVT有一定的并发症发生率,应采取各种措施加以预防。

Objective： To investigate the complications of integrated interventional treatment for mixed type of lower extremity deep vein thrombosis （LEDVT） and their management. Methods： The clinical data of 488 patients with acute or subacute mixed type LEDVT treared during 7 years were retrospectively analyzed. All patients underwent inferior vena cava filter placement, and subsequently underwent mechanical thrombus fragmentation and aspiration, catheter-directed thrombolysis and anticoagulant therapy. Intrapulmonary catheter-directed thrombolysis was performed in patients with symptomatic pulmonary embolism （PE）, and balloon dilation angioplasty （percutaneous transluminal angioplasty, PTA） or post-PTA stent insertion was performed in patients with iliac vein stenosis or occlusion. Results： The incidence of symptomatic PE was 7.58% （37/488）, and 2 of the PE patients （2/37） died in spite of aggressive salvage attempts, q＇he incidence of vascular injury and large thrombus trapped by the filter during the integrated interventional treatment was 9.22% （45/488） and 16.60% （81/488）, respectively. The incidence of abnormal bleeding during postoperative anticoagulation was 5.53% （27/488）, and 2 of these patients died due to intracerebral hemorrhage. Four hundred and fifty-one patients were followed up for 4 to 94 months with average period of 41 months, during which time, the incidence of post-thrombotic syndrome （PTS） was 11.53% （52/451）, and the incidence of post-PTA restenosis and reocclusion after stent placement was 40.19% （43/107） and 6.6% （7/106）, respectively. Conclusion： Integrated interventional treatment for mixed type of LEDVT carries a certain risk of complications, so several preventive measures should be taken.