血管腔内微创治疗下肢深静脉血栓1211例

Endovascular minimally invasive therapy for lower extremity deep venous thrombosis with 1211 cases

目的探讨血管腔内微创治疗急性下肢深静脉血栓形成（LEDVT）的临床效果。方法回顾性分析1 211例急性LEDVT患者的临床资料。中央型375例单纯机械性血栓抽吸,患侧股静脉顺行穿刺,导丝引导下插入12~14 F鞘管手动抽吸髂、股静脉内血栓;混合型570例患侧股静脉顺行穿刺直接抽吸清除髋上髂、股静脉内血栓;髋下股、腘静脉血栓,由健侧股静脉顺行穿刺,采用＂穿线＂或导丝＂抓捕＂技术,建立＂健、患侧股静脉工作导丝＂通路,经健侧置入7 F＂翻山鞘管＂至患侧髂静脉内,并沿导丝插入Fogarty导管,顺应静脉瓣膜方向将血栓拉至患侧髂静脉内,再经患侧股静脉抽吸血栓;周围型266例,患侧股静脉逆行穿刺,在导丝保护下插入12 F鞘管手动抽吸胫前、胫后及腓静脉内血栓。术后残存血栓配合溶栓治疗。492例髂静脉严重狭窄或闭塞行血管成形和支架植入。结果介入治疗总有效率99.34%（1 203/1 211）,无效0.66%（8/1 211）,平均住院（6.5±1.2）d。患肢肿胀、疼痛均于介入治疗后1~2 d内开始消退或减轻。介入取栓及溶栓效果：Ⅰ级61.44%（744/1211）;Ⅱ级29.31%（355/1 211）;Ⅲ级8.59%（104/1 211）;Ⅳ级0.66%（8/1 211）。出院时健、患肢膝上、下15 cm处周径差与入院比较明显缩小,差异有统计学意义（均P〈0.05）。术后随访6~24个月,临床表现＂优＂75.06%,＂良＂16.55%,＂中＂7.29%,＂差＂1.10%。术后12个月和24个月支架通畅率分别为92.07%和88.62%。结论血管腔内微创治疗LEDVT,能尽早清除静脉腔内血栓,迅速恢复通畅的血流,缩短病程,近、中期疗效显著,以中央型DVT最佳。

【Objective】 To investigate the clinical effect of endovascular minimally invasive therapy for acute lower extremity deep venous thrombosis（LEDVT）. 【Methods】 The clinical data of 1 211 patients with acute LEDVT were analyzed retrospectively. 375 patients of central type DVT were treated with mechanical aspiration thrombectomy, the superficial femoral vein was accessed under local anesthesia, a 12 ~ 14 F sheath was inserted via guide-wire to aspirate iliofemoral thrombus. 570 cases of mixed type DVT antegrade puncture affected femoral vein to remove iliofemoral thrombus by mechanical aspiration thrombectomy. As for femoralpopliteal thrombus, a 4 F Cobra was introduced to IVC-iliac vein junction via contralateral femoral vein access, the technology of ＂threading＂ or ＂capturing＂ was utilized to put the guide-wire out in vitro to establish the ＂health-affected femoral vein working guide-wire＂ pathway. Then a 7 F ＇crossed sheath＇ was inserted to iliac vein to establish ＂working track＂. Fogarty balloon was inserted to pull femoralpopliteal thrombus to iliac vein via the guide-wire, then mechanical aspiration thrombectomy was performed via ipsilateral vein; 266 patients of peripheral type were treated by aspirating thrombus of anterior tibial, posterior veins all the patients with residual thrombus received thrombolytic therapy. 213 patients with stenosis or obstruction were underwent transluminal balloon angioplasty and stent placement. 【Results】 Total effective rate of interventional therapy was 99.34%（1 203 / 1 211）, poor was 0.66%（8 / 1 211）, the hospitalization time was（6.5 ± 1.2） days. The tumescence and pain of affected limbs were alleviated after 1 ~ 2 days of postprocedure interventional treatment. The effect of interventional thrombectomy and thrombolytic therapy were Grade Ⅰ 61.44%（744 / 1 211）, Grade Ⅱ 29.31%（355 / 1 211）, Grade Ⅲ 8.59%（104 / 1 211）, Grade Ⅳ 0.66%（8 / 1 211） respectively. The circumstance differences at 15 cm of above and below knee of healthy and affected limbs on discharge were significantly reduced compared with admission, the difference were statistically significance（Both P 0.05）. Postprocedure 6 ~ 24 months follow-up, ＂Excellent＂ 75.06%, ＂Moderate＂ 16.54%, ＂Mild＂ 7.29%, ＂Poor＂ 1.10%. The patency rate of 12, 24 months follow-up were 92.07%, 88.62% respectively. 【Conclusion】 Endovascular minimally invasive therapy for acute lower extremity deep venous thrombosis, can remove thrombus as soon as possible and restore the blood flow instantly, shorten hospitalization, having a notable clinical effect of short and medium-term, the central type of DVT is best.