左髂静脉压迫并发急性髂股静脉血栓形成综合治疗临床分析

Clinical analysis of the complex treatment of acute iliac femoral vein thrombosis complicated with left iliac vein compression

目的:探索左髂静脉压迫并发急性髂股静脉血栓形成的综合治疗方案,并评价其临床效果和安全性。方法:回顾性分析2016年1月至2018年2月,我科收治32例左髂静脉压迫并发急性髂股静脉血栓患者。根据治疗效果将其分为Ⅰ到Ⅴ级。术后随访1,6,12个月和24个月行CTV。评估静脉血流通畅情况,支架断裂受压及通畅情况。根据Villalta评分标准评估血栓后综合征及分级。在综合治疗方案中,选择电话、门诊或住院进行血管超声及血管造影或者下肢CTV的方法进行随访,观察下肢深静脉通畅率,肢体肿胀情况等并发症发生情况。结果:随访1～24个月,髂静脉支架通畅率为100%,其中3例为支架内附壁血栓,支架内血流仍通畅,术后下肢遗留轻度肿胀,均能耐受。术后左下肢肿胀症状均快速减轻或消失,造影显示左股静脉至髂静脉血栓基本完全消除,下肢血管CTV检查示:髂静脉支架均通畅,随访3～24个月临床疗效满意。32例患者术后均恢复静脉血流,治疗效果评价:Ⅰ级28例,Ⅱ级4例,无Ⅲ～Ⅴ级。所有患者术后下肢肿胀症状均缓解,无围手术期出血、肺栓塞等并发症及死亡。平均随访8个月(1～24个月),下肢静脉均血流通畅,无复发,3例患者于6个月后出现轻度血栓后综合征。结论:综合治疗方案可以明显增加减溶效果,缩短溶栓药物用量和使用时间,减少出血并发症,同时显著减少血栓后综合征发生率。

Objective:To explore the complex treatment of left iliac vein compression complicated with acute iliofemoral thrombosis,and to evaluate its clinical effect and safety.Methods:This retrospective study enrolled32patients diagnosed with acute iliac femoral vein thrombosis complicated with left iliac vein compression in our department between January2016and February2018.The therapeutic effect was evaluated and classified from grade I to gradeⅤ.Follow up was performed at1,3,6,12and24months after the operation,and CT examination(CTV)was performed to assess patency of venous flow and fracture,being pressed and patency of the stent.Post thrombotic syndrome and its grades were accessed based on the Villalta scores.Follow up method of the complex treatment include telephone,outpatient or hospitalization for color doppler ultrasound,angiography or lower extremity CTV.The deep vein patency rate,swelling of limbs and other complications were observed and recorded.Results:The patency rate of the iliac vein stent was100%during the 24 months’follow up.In particular,3cases among them were mural thrombus with the blood flow in the stent being still unobstructed and suffered mild swelling of the lower extremities which can be tolerated.Swollen of left lower extremity decreased rapidly or disappeared after operation.Angiography showed that the left iliac femoral vein thrombosis was nearly completely eliminated.CT(CTV)examination of the lower extremities showed that the iliac vein stent was unobstructed.The clinical efficacy during the follow-up period of3~24months was satisfactory.In all32patients,venous blood flow was restored after operation.The therapeutic effect was evaluated as follows,28cases were gradeⅠ,4cases were gradeⅡ,and no case was gradeⅢ~Ⅴ.The swelling symptom of all patients was relieved after operation,and there were no complications such as perioperative bleeding,pulmonary embolism or death.The average follow-up time was8months.Venous blood flow of all the patents were restored and there were no relapses.3patients developed mild post thrombotic syndrome after6months of the operation.Conclusion:For patients of acute iliac femoral vein thrombosis complicated with left iliac vein compression,the complex treatment can significantly increase the efficiency of volume reduction,reduce the dosage of thrombolytic drugs,the time consumed by thrombolytic,bleeding complications and the incidence of post thrombus syndrome.