下肢深静脉血栓形成后综合征介入治疗体会

The experience of interventional therapy for deep vein post-thrombotic syndrome of lower extremity

目的探讨下肢深静脉血栓形成后综合征（PTS）的介入治疗效果。方法对2011年1月至2014年1月65例PTS患者（75条患肢）的临床资料进行回顾性分析、总结,观察临床治疗效果。其中46例患者行球囊扩张并支架植入术,16例患者行单纯球囊扩张术,3例患者经反复尝试导丝无法通过闭塞段,术后保守治疗。结果本组75条肢体,除4条肢体无法探通外,其余71条肢体经介入手术使狭窄及闭塞血管完全恢复正常流入道和流出道,成功率94.67%;4条无法探通肢体均为髂股静脉闭塞型,其中3条左髂总静脉段未能开通,但远端静脉血流经侧支血管回流至对侧髂静脉。51条肢体髂静脉经PTA后造影显示管腔狭窄仍〉50%,植入相应大小裸支架。35条肢体股腘段静脉经PTA后管腔直径均〉80%,未植入支架。随访患者60例,随访率92.30%,随访时间1～4年。其中40条患肢症状明显缓解（53.3%）,31条患肢部分缓解（41.3%）,4条患肢无明显缓解（5.3%）。结论 PTS的介入治疗效果可靠。

Objective To investigate the effect of interventional treatment for deep vein post- thrombotic syndrome（ PTS） of lower extremity. Methods The clinical effect of 65 cases of PTS（ 75 lower limbs） treated from January 2011 to January 2014 were retrospectively analyzed. Of the 65 patients,46 treated with balloon dilatation and stent placement,16 treated with balloon dilatation,3 received conservative treatment because the guide wire failed to go through the occlusion section of the vein. Results Of 75 affected limbs,71 had normal inflow and outflow after surgical intervention（ 94. 67%）. The 4 failed cases were all iliofemoral vein occlusion,in which 3 had left iliac vein occlusion and the distal venous blood flow went through the collateral vessels back into the contralateral iliac vein. Iliac vein had stenosis 〉50% in 51 limbs after PTA,and the right size stent was then implanted. The femoral popliteal segment vein angiography revealed that the minimal lumen diameter 〉80% in 35 affected limbs after PTA,and the stent was not implanted. Sixty patients were followed- up for 1- 4 years,the follow- up rate was92. 30%. The follow- up showed significant symptom relief in 40 limbs（ 53. 3%）,partial remission in 31 limbs（ 41. 3%）,no improvement in4 limbs（ 5. 3%）. Conclusion The effect of interventional therapy is reliable for the treatment of deep vein PTS of lower extremity.