同期血栓机械清除联合髂静脉支架植入治疗急性下肢深静脉血栓形成12例

Percutaneous mechanical thrombectomy with subsequent iliac vein stent implantation accomplished by single-procedure for acute deep venous thrombosis of lower extremity:preliminary results in 12 cases

目的评价经皮机械血栓清除术(PMT)联合髂静脉支架植入一期治疗急性下肢深静脉血栓形成(DVT)的可行性、安全性及有效性。方法 2014年12月至2016年1月收治12例急性下肢DVT伴左侧髂静脉受压综合征(IVCS)患者,男3例,女9例,平均年龄(50.42±16.21)岁;均有左下肢肿胀、疼痛症状,其中中央型3例,混合型9例。所有患者术前均置入下腔静脉滤器,术后取出。Angio Jet血栓清除导管PMT术、球囊扩张和髂静脉支架植入均在同期完成,复查造影有残余血栓时保留鞘管,给予溶栓治疗。术后1、3、6、12个月门诊随访,彩色超声和(或)下肢静脉造影复查了解深静脉及支架内血流通畅情况。结果 12例患者均同期完成手术,技术成功率100%。手术时间60~110 min,平均(96.25±14.32)min;血栓抽吸时间51~280 s,平均(199.92±74.89)s。血栓清除率Ⅲ级10例,Ⅱ级2例,临床症状均得到缓解。除部分患者在左髂总静脉球囊扩张中有不同程度疼痛外,无肺栓塞、严重出血等并发症发生。平均随访(5.58±2.75)个月,11例彩色超声和(或)下肢静脉造影提示深静脉及髂静脉支架内血流通畅,1例脑星形细胞瘤手术患者复发。结论同期PMT联合髂静脉支架植入治疗急性下肢DVT方法安全可行,初步临床疗效满意。

Objective To evaluate the feasibility, safety and effectiveness of percutaneous mechanical thrombectomy （PMT） and iliac vein stent implantation which are accomplished by single-procedure in treating acute deep venous thrombosis （DVT） of lower extremity. Methods During the period from December 2014 to January 2016, a total of 12 patients with acute DVT of lower extremity, including 3 males and 9 females with a mean age of （50.42±16.21） years old, were admitted to authors＇ hospital to receive treatment. Clinically, all patients presented with left leg swelling and pain. Central type of DVT was seen in 3 patients and mixed type of DVT was found in 9 patients. Preoperative placement of inferior vena cava filter was employed in all patients, which was retrieved after the treatment. PMT by using AngioJet thrombus removal catheter, balloon angioplasty, and iliac vein stent implantation were successively carried out during the same procedure. When residual thrombus was identified on checkup angiography the catheter sheath would be reserved, and the thrombolytie therapy would be adopted. The patients were followed up at outpatient clinic at one, 3, 6 and 12 months after the treatment, and reexamination of color ultrasound and/or lower limb venography was used to assess the blood flow in the deep veins and in the stents. Results The combination of several therapies was accomplished in a single procedure, the technical success rate was 100%. The used time for the operation was 60-110 minutes, with a mean of （96.25±14.32） minutes. The used time for thrombus aspiration was 51-280 seconds, with a mean of （199.92±74.89） seconds. Thrombus clearance rate of grade ill was obtained in 10 patients, and thrombus clearance rate of grade II was seen in 2 patients; the clinical symptoms were improved in all patients. Except some patients complained of different degrees of pain during the performance of balloon dilatation of left common iliac vein, no serious complications such as pulmonary embolism, severe hemorrhage, etc. occurred. The patients were followed up for （5.58±2.75） months; color ultrasound and/or lower limb venography performed in 11 patients showed that the blood flow in deep veins and iliac vein stents was unobstructed, and relapse of DVT was observed in one patient with cerebral astrocytoma. Conelusion For the treatment of DVT of lower extremity, PMT combined with iliac vein stent implantation that is accomplished by single-procedure is safe and feasible, its preliminary clinical results are satisfactory.