深静脉血栓形成后综合征腔内治疗的单中心经验

Single Center Experience of Endovascular Technique in the Treatment of Post Thrombotic Syndrome

目的总结深静脉血栓形成后综合征(PTS)腔内治疗的单中心经验,评估其安全性及有效性。方法回顾性分析2018年8月至2020年6月复旦大学附属中山医院厦门医院收治的14例PTS患者的临床资料,均应用腔内治疗,统计并分析患者特点、手术信息及随访情况。结果患者均具有明确的血栓形成史,为闭塞性病变,2例累及双侧下肢,10例累及左下肢,2例累及右下肢;4例超声提示存在深静脉瓣膜返流。手术情况为,2例未能通过病变,仅造影;5例因病变较长,流入道不佳,仅行球囊扩张;7例行球囊扩张和支架植入术,各植入金属裸支2枚,其中1例因后扩支架致血管破裂植入补救性覆膜支架1枚。手术成功率、术后1年初级通畅率分别为85.7%、91.7%,围手术期无心脑血管意外、死亡等重大并发症,术后3个月,临床症状得到了明显改善。随访结果为,1例术后1个月出现双下肢及下腔静脉血栓形成,再次行深静脉血栓吸栓和置管溶栓治疗;11例所有靶血管通畅,其中,7例行支架植入患者无支架断裂、移位、支架内狭窄等并发症发生。结论腔内治疗应用于PTS患者的临床效果显著,手术成功率、1年初级通畅率及安全性均较高。流入及流出道的充分评估、支架的选择和植入及有效的抗栓方案是决定PTS腔内治疗远期通畅性的关键因素。

Objective The single center experience of endovascular technique in the treatment of post-thrombotic syndrome(PTS)were analyzed and its safety and efficacy were evaluated.Methods 14 PTS patients treated with endovascular technique in Zhongshan Hospital,Fudan University(Xiamen Branch)from August 2018 to June 2020 were enrolled in this study.The patients'baseline demographics,operation details and follow-up data were prospectively analyzed.Results All patients suffered occlusive lesions with thrombosis history.There were 2 cases of bilaterally extremities,10 cases of left side,and the other 2 cases of right side.Deep venous reflux confirmed by ultrasound in 4 patients.Among them,2 cases only received angiography due to failed passage of wire through lesion,5 cases received percutaneous transluminal angioplasty without stent deployed because of longer lesion and insufficient inflow.Two bare-mental stents were implanted in 7 patients respectively and a self-expandable covered stent was performed to rescue external iliac vein rupture in 1 patient.The technical success rate was 85.7%and the vascular primary patency was 91.7%1 year later.Perioperatively,no major adverse complications including myocardial infarction,cerebral infarction and death occurred.The recurrent thrombotic event was observed in a patient and dissolved after percutaneous mechanical thrombectomy and catheter-directed thrombosis at 1 month postoperative follow up.All target veins of 11 cases maintained patent during follow-up and no stent-related complications such as fracture,migration or restenosis were found in 7 cases who were treated with stent implanted.3 months after operations,patients'clinical symptoms were improved obviously.Conclusions The application effects of endovascular technique in the treatment of PTS patients were obvious,with high technique success rate,1-year vascular primary patency rate and safety.The adequate assessment of inflow and outflow tracts,selection and placement of stents and effective antithrombotic regimen were the key factors which determined the long-term patency of PTS patients treated with endovascular technique.