经皮腔内介入治疗双侧髂股静脉血栓形成18例

Percutaneous endovascular interventional treatment for bilateral iliofemoral venous thrombosis: clinical results of 18 cases

目的探讨经皮腔内介入治疗双侧髂股静脉血栓形成的临床效果。方法回顾性分析2012年11月—2016年2月收治的18例双侧髂股静脉血栓形成患者临床资料。其中男7例,女11例;年龄51~86岁,平均(66.2±7.8)岁。18例患者均行介入手术治疗,急性期或亚急性期患者在下腔静脉滤器保护下行机械性血栓抽吸术,术后即刻造影,若髂静脉残余狭窄则行球囊扩张或支架置入治疗;慢性期直接行球囊扩张或支架置入治疗。结果 18例患者手术均获得成功,治疗前后患肢大腿与小腿周径差分别为(7.3±2.1)、(4.6±2.7)cm。13例合并髂静脉狭窄或闭塞患者行球囊扩张和支架置入治疗,共放置20枚自膨式支架。18例获随访12~34个月,平均(21.5±7.3)个月,分别在术后9、12个月出现支架狭窄1例,血栓后综合征1例。12个月初次通畅率和二次通畅率分别为88.9%(16/18)和100.0%(18/18)。结论腔内介入治疗双侧髂股静脉血栓形成,成功率高,临床效果显著,是安全有效的方法。

Objective To investigate the clinical effect ofpercutaneous endovascular interventional treatment for bilateral iliofemoral venous thrombosis. Methods From November 2012 to February 2016, the clinical data of 18 patients with bilateral iliofemoral venous thrombosis were retrospectively analyzed. All patients including 7 males and 11 females, aged from 51 to 86 years with an average of （66.2＋7.8） years old. All patients underwent interventional treatment, and mechanical aspiration thrombectomy was performed under the protection of inferior vena cava filter at the acute or subacute phase; those whose venography showed iliac vein stenosis received balloon dilatation and self-expandable stents immediately. Iliac vein stenosis received balloon dilatation and self-expandable stents immediately at the chronic phase. Results The treatment was successful in all patients. The circumference difference of thigh and calf was （7.3＋2.1） and （4.6＋2.7） cm respectively before and after treatment. Thirteen patients with stenosis or occlusion of the iliac vein were treated with adjunctive balloon dilatation and stent placement, and 20 self-expandable stents were inserted successfully. All the patients were followed up for 12-34 months with an average of （21.5＋7.3） months; stenosis or occlusion of the stent were seen in 1 patient after 9 months; post thrombotic syndrome was observed in 1 patient after 12 months. The 12- month primary patency rate and secondary patency rate was 88.9% （16/18） and 100.0% （18/18）, respectively. Conclusion Endovascular interventional therapy of bilateral iliofemoral venous thrombosis is a safe and effective method.