下肢深静脉血栓形成介入治疗前后CT血管成像的临床价值

The Clinical Value of CT Angiography in Lower Extremity Deep Vein Thrombosis Before and After Interventional Treatment

目的探讨下肢深静脉血栓形成(DVT)介入治疗前后CT血管成像(CTA)的临床价值。方法 54例临床诊断下肢DVT的患者拟介入术前、30例下肢DVT患者介入术后行128层螺旋CT扫描及血管三维重建,观察下肢DVT的CT表现,与DSA检查进行比较,计算DVT的CTA诊断符合率。结果介入术前组病例中,DVT分布在左下肢31例,右下肢16例,双下肢7例,26例DVT的范围和近心端CTA显示较DSA清楚,下肢DVT合并肺动脉栓塞8例。21例伴有髂静脉受压综合征,10例CT检查显示伴有其他原因的静脉阻塞:布-加氏综合征2例,盆腔肿块压迫髂总静脉4例,盆腔血肿压迫髂静脉1例,腹股沟区淋巴结、囊肿压迫髂外静脉3例。介入术后组病例中,25例髂股深静脉CTA显示:12例静脉血管成型术加血管内支架术,9例位置形态正常,1例位置异常,1例血管内支架术远端血栓形成,1例血管内支架静脉周围血肿形成;其余13例,6例下肢静脉通畅,4例血栓复发,3例下肢慢性DVT综合征,表现为静脉纤细、不光整、闭塞或部分闭塞。12例下腔静脉内滤器置入术后的CT检查显示:7例位置正常,5例下腔静脉内滤器变形或角度异常;其中4例可见滤器附近少量血栓,2例下腔静脉髂静脉广泛DVT形成。以DSA为诊断标准,DVT的CTA诊断符合率为98.8%。结论 CTA能准确诊断下肢DVT的机械性梗阻原因,清楚地显示DVT的位置、范围,与常规DSA对比有较高的符合率,介入术前CTA检查有一定的价值;CTA能够明确显示介入治疗后并发症是否存在以及病变程度,对DVT介入治疗后并发症的诊断有重要价值。

Objective To explore the clinical value of CTA examination in the lower extremity deep vein thrombosis before and after interventional treatment. Methods Fifty four cases of patients suspected with lower extremity deep vein thrombosis before interventional treatment and 30 cases of patients after interventional treatment underwent 128 slices helical CT angiography. The CT manifestation of lower extremity deep vein thrombosis was observed. The findings of CTA were compared with that of DSA and the accuracy of CTA was analyzed. Results In the before interventional treatment group cases,distribution of thrombus was observed. There were 31 cases in the left legs,16 cases in the right legs and 7 cases in double lower legs. Compared with DSA,CTA displayed the scope and proximal of vein thrombosis clearly in 26 cases.Eight cases of lower extremity deep vein thrombosis associated with pulmonary embolism. There were 21 patients with iliac vein compression syndrome. Ten cases of CT examination were showed venous occlusion for other reasons. There were cloth plus syndrome in 2 cases,pelvic mass oppression common iliac veins in 4 cases,pelvic hematoma compressed iliac veins in1 case,inguinal lymph nodes or cyst compressed iliac femoral vein in 3 patients. In the after interventional treatment group cases,25 cases of deep iliac femoral venous were CTA examination. Veins forming surgery and endovascular stent in 12 cases,there were 9 cases of normal form stent,1 case of abnormal position. One case the hematoma was formed around in blood vessel. In the other 13 cases,there were 6 cases of intravenous blood flowing,4 cases of recurrent thrombosis and 3cases of chronic deep venous thrombosis syndrome,characterized by vein slender,coarse,complete or partial occlusion. In12 cases with inferior vena cava filter placed,there were 7 cases of normal position,5 cases of inferior vena cava filter in abnormal shape or angle,4 cases of a small amount of blood clots near the filter,2 cases of inferior vena cava and iliac vein thrombosis extensively. According to the diagnosis criteria for DSA,CTA diagnostic coincidence rate was 98. 8%. Conclusion CTA can accurately diagnose mechanical obstruction reasons of deep vein thrombosis in lower limb; clearly show the location and scope of the thrombus. Compared with conventional DSA,CTA has a high coincidence rate,so before interventional treatment examination of CTA is a certain value. CTA can clearly show the complications after interventional therapy,therefore after interventional treatment examination of CTA is a special value.