慢性血管内血栓物理性治疗的疗效及影响因素

Mechanical Therapy for Chronic Vascular Thrombus: Efficacy and Influencing Factors

目的 探讨物理性血管内血栓去除 /开通治疗慢性血栓的可行性 ,分析疗效及影响因素。资料与方法 本组 32例患者均经MRA、血管超声及造影证实 ,其中 17例患慢性心衰和 /或血管性疾病 ,15例为重度糖尿病。血栓位于髂动脉 13例 (左侧 6例 ,右侧 4例 ,双侧 3例 ) ,股动脉 6例 ,动脉 3例 ,髂静脉 9例 (左侧 6例 ,右侧 3例 ) ,门静脉 1例。血栓的长度为 3～ 8cm ,直径为 5～ 10mm。 9例髂静脉血栓患者物理性治疗前先行放置下腔静脉滤过器。射频消融 (ATD)治疗 9例 (静脉 7例 ) ,经皮电动网篮 (PTD) 2例 (门静脉 ) ,流变溶栓 (Oasis) 3例 (动脉 2例 ,静脉 1例 ) ,内支架直接开通 18例 (均为动脉 )。所有患者在治疗过程中采用 5 0万U的尿激酶通过导管内直接溶栓。物理性血栓切除后如造影证实血管狭窄者 ,狭窄部行血管内支架放置。术后治疗包括内科溶栓、肝素抗凝和改善微循环等药物治疗。每 2个月做血管超声或CT血管重建随访及临床症状随访。结果 30例 (93.8% )成功进行了物理性血栓去除和 /或开通 ,1例门脉血栓者失败 ,1例股动脉血栓患者同时行ATD和Oasis失败后行外科切开取栓。 2 9例 (90 .6 % )临床症状在 1个月内明显改善和消失。物理性治疗后 3、6、12个月 ,血管超声随访累计血管通畅率分别为 10 0 %?

Objective To investigate the feasibility of mechanical thrombectomy or stent implantation for the treatment of chronic vascular thrombus.Materials and Methods Thirty-two cases, including 21 males and 11 females, aged 46～80 (mean 64.8 years), with chronic vascular thrombus were enrolled in this study. The diagnosis was confirmed by MRA, sonography and angiography. The underlying diseases included chronic heart failure with vascular disorders (n=17) or severe diabetes (n=16). The thrombi were located at iliac arteries (n=13), femoral arteries (n=6), popliteal arteries (n=3), iliac veins (n=9), portal vein (n=1). The length of the thrombi varied from 3 to 8 cm, and the diameter from 5 to 10 mm. Filters were placed in inferior vena cava before venous thrombus treatment (n=9). Mechanical thrombectomy were undertaken with Amplatz thrombectomy device (ATP, n=9), with Arrow percutaneous thrombectomy device (PTD, n=2), with Oasis (n=3), or direct stenting (n=18). Catheter-directed thrombolysis with urokinase (500,000 unit) was usually used during mechanical thrombectomy. If stenosis was confirmed by angiography, stent implantation was done during thrombectomy. After thrombectomy, medication with thrombolytic, anticoagulative and microcirculation-improving agents was started. Patients were followed up every two months with vascular sonography or CT vascular reconstruction.Results Thrombectomy was successful in 29 cases (90.6%). Clinical symptoms, such as ischemia, swelling and limited activity were obviously improved or disappeared in 30 cases within 30 days after the procedure. Failure occurred in one case with portal vein thrombus. Surgical remove of the thrombus had to be done in another case with femoral artery thrombus as both ATD and Oasis were unsuccessful. Follow-up with vascular sonography at 3, 6 and 12 months showed that accumulative patent rate of the diseased vessels treated with thrombectomy and direct stenting was 100%, 85.4% and 73.2%, while restoration to normal of the blood flow was 76.5%, 65.4% and 60.1%, respectively.Conclusion Interventional mechanical thrombectomy or/and stenting is a new choice in treating chronic vascular thrombus. Its therapeutic effect is immediate and sure, but to clarify its long-term efficacy long-term observation is needed.