髂-股静脉血栓形成的影像诊断与介入治疗

Imaging Techniques and Interventional Treatment for the Iliofemoral Venous Thrombosis

目的:阐明髂-股静脉血栓形成的不同影像学诊断手段,评价其介入治疗的方法与价值。方法:回顾性分析24例髂-股静脉血栓形成患者的影像诊断与介入治疗资料。24例患者均行患肢彩色多普勒影像诊断术(CDFl)检查,16例行血管造影检查,8例行MRI检查。按治疗方式分为2组:15例行静脉内导管直接灌注溶栓治疗(A组);9例行超声血栓消融结合导管直接灌注溶栓治疗(B组)。结果:经CDFI、血管造影及MRI等影像学检查均获得了明确的诊断。8只下腔静脉滤器均展开良好,无移位。24例髂-股静脉血栓形成者均治疗成功,无严重并发症发生,其中临床痊愈5例,显效10例,有效9例,愈显率为62.50%,A、B两组间无显著性差异。但A组的溶栓时间明显长于B组(P<0.05),A组的尿激酶用量明显多于B组(P<0.05)。结论:CDFI、血管造影及MRI等影像学检查的相互补充有助于本病的正确诊断。血管内介入治疗是髂-股静脉血栓形成的安全有效的治疗方法。

Objective: To illustrate the different imaging options for the diagnosis of iliofemoral venous thrombosis and to assess the value of interventional strategies for iliofemoral venous thrombosis treatment in an emergency setting. Methods: 24 cases with iliofemoral venous thrombosis were analyzed retrospectively. The color Doppler flow image(CDFI) were performed in all cases, venography in 16 cases, magnetic resonance imaging(MRI) in 18 cases. Interventional intravascular treatment was preformed in all cases: 15 cases were only treated with catheter-directed thrombolysis (Group A), and 9 cases were managed with ultrasound ablation and catheter-directed thrombolysis together (Group B) . Results: In the 24 cases, correct diagnoses were obtained through the CDFI, venography and MRI. Inferior vena cava filter were successfully deployed without disposition and migration in 8 cases. Occluded iliofemoral venous were recanalized in all cases without serious complication. Among 24 cases, 5 cases were clinically cured, 10 cases markedly effectively, 9 cases effectively. The cured and marked effective rate was 62.5% . There were no statistically significant difference between group A and group B( P > 0.05). However, the mean time of group A was longer than that of the group B( P < 0.05), and the mean dosage of urokinase was more than that of the group B( P < 0.05) . Conclusion: CDFI, venography and MRI have superior diagnostic value for the iliofemoral venous thrombosis, and they are complementary in diagnosis of it. Interventional intravascular treatment is a safe and effective treatment for the iliofemoral venous thrombosis.