减容治疗在左侧下肢深静脉血栓形成合并Cockett综合征治疗中的应用价值

Value of Debulking treatment for iliac vein compression syndrome with secondary acute deep venous thrombosis

目的探讨减容治疗在急性左侧下肢深静脉血栓形成(deep venous thrombosis,DVT)合并Cockett综合征的应用价值。方法回顾性分析2013年11月至2016年6月左侧下肢急性DVT合并Cockett综合征患者的病例资料28例,均应用下腔静脉滤器置入术、切开或者经皮穿刺左侧下肢深静脉置管溶栓或者Aspirex导管机械性取栓(percutaneous mechanical thrombectomy,PMT)、左侧髂静脉狭窄或者闭塞段球囊扩张和支架植入术进行治疗。观察患者手术前后左侧下肢症状和体征,并且应用超声或者DSA进行随访观察。结果 28例患者均经左侧下肢深静脉造影检查明确诊断。本组技术成功率为100%,患者术后下肢肿胀和疼痛等症状消失。4例行左侧胫后静脉切开的患者在溶栓治疗期间出现伤口渗血,其余患者未发现穿刺点及其他部位出血。1例出院后7 d发生血栓复发,经足量抗凝治疗后症状改善。平均随访时间为10.6个月(范围为2~24个月),无血栓复发,髂静脉支架均通畅。结论减容治疗在左侧下肢DVT合并Cockett综合征的治疗中具有重要价值,为后续PTA+STENT等治疗创造了有利条件。

Objective To evaluate the feasibility, safety, and effectiveness of debulking treatment for iliac vein compression syndrome(Cockett syndrome) with secondary acute deep venous thrombosis(DVT). Methods From November 2013 to June 2016, a total of 28 patients with DVT due to Cockett syndrome underwent endovascular treatment, consisting of inferior vena cava filter implantation, catheter direct thrombolysis(CDT) or percutaneous mechanical thrombetomy(PMT), percutaneous transluminal angioplasty(PTA), and stent placement. The symptoms and signs between beforeand after operation were observed. Patients were followed-up, and stent patency was assessed by means of duplex ultrosonography or DSA. Results All patients were exactly diagnosed by antegrade lower extremity venography. Incision bleeding occurred in 4 cases with open procedure to separate the posterior tibial vein, otherwise no symptomatic bleeding happened in that with percutaneous puncture. Endovascular procedures were performed successfully in all patients. Symptoms of legs welling and pains disappeared. Recurrent thrombosis was observed in one case within 7 days of being discharged from hospital and improved with full anticogulation. The mean follow-up period was 10.6 months(2-24 months). No symptomatic thrombosis recurrence was observed. All stents kept patent. Conclusions Debulking treatment can create better condition for subsequent treatment and is a feasible, safe, and effective method for DVT due to Cockett syndrome.