下腔静脉滤器在下肢深静脉血栓治疗中的意义

目的评价置入下腔静脉滤器预防下肢深静脉血栓脱落引起肺栓塞的价值及实行导管溶栓的方法.方法34例下肢深静脉血栓患者分别经右侧股静脉(26例)或右颈静脉(8例)置入波士顿公司的Greenfield滤器或巴德公司Simon's滤器.下腔静脉滤器置人后,将溶栓导管经右股静脉插人到左髂总静脉,经右颈内静脉插入到左髂总静脉进行溶栓.药物尿激酶100～150万u.结果下腔静脉滤器置入全部成功.溶栓经右侧股静脉26例,成功12例,成功率为47%;经颈静脉8例均成功.结论置人下腔静脉滤器防肺栓塞是操作简单、安全有效的方法.经颈静脉溶栓,成功率高,效果好,值得推广.     

永久性和临时性腔静脉过滤器在辅助治疗静脉血栓中的作用

目的探讨腔静脉滤器置入在外周静脉血栓患者溶栓治疗中预防异位栓塞的应用价值.材料和方法7例下肢静脉血栓及1例永存动脉干合并右颈内静脉血栓的患者,分别经静脉置入永久性腔静脉滤器或临时性腔静脉滤器后,用大量尿激酶顺行或全身静脉溶栓治疗.结果8例患者经10～15天治疗后症状消失,血栓完全或部分溶解,血管开通,未出现并发症及异位栓塞.结论置入腔静脉滤器在外周静脉血栓患者溶栓治疗中是预防静脉血栓脱落导致异位栓塞的有效方法.     

超声引导下置管溶栓治疗下肢深静脉血栓

目的 探讨超声引导下经皮置管溶栓治疗下肢深静脉血栓形成(DVT)的临床应用价值.方法 自2009年9月至2011年9月共收治下肢DVT患者34例,均采用下腔静脉滤器置入后,患肢在超声引导下经皮置管,持续导管内给予溶栓药物尿激酶50 万u/d和肝素5 000 u/d,交替使用.其中2例患者合并下腔静脉血栓,采用经颈静脉途径释放下腔静脉滤器;2例患者采用大隐静脉置管;其余均采用经皮腘静脉置管.结果 所有患者均置管成功,放置溶栓导管5 ～ 7 d.27例患者术后下肢肿胀基本消失,活动能力明显改善.5例患者活动后仍有较明显乏力和沉重感.1例患者术后3个月复发,再次置管后好转.1例患者术后6个月复发合并健侧下肢DVT,采用外周血管溶栓治疗.所有患者均采用DSA了解溶栓情况,26例患者髂股静脉术后连续性通畅,8例患者阶段性通畅.结论 超声引导下经皮置管溶栓治疗具有创伤小、定位准确、药物剂量个人化以及溶栓率高等优点,是治疗DVT的有效方法.     

可回收式滤器在上腔静脉的临床应用

目的 探讨Tulip可回收滤器在上腔静脉内植入的安全性及预防肺动脉栓塞的临床应用价值.方法 10例急性或亚急性上肢、头颈部深静脉血栓和肺动脉栓塞患者.在上腔静脉内置入滤器后,配合上肢、头颈部静脉局部置管溶栓治疗.术后观察上肢、头颈静脉症状,有无肺动脉栓塞以及滤器形态、位置变化.结果 10例滤器均置入成功.滤器均无移位、...     

临时性腔静脉滤器在静脉血栓溶栓治疗中的应用

目的：探讨临时性腔静脉滤器置入在外周静脉血栓患者溶栓治疗中预防异位栓塞的应用价值。方法：10例下肢静脉血栓及1例永存动脉干合并右颈内静脉血栓的患者,分别经静脉置入临时性腔静脉滤器后,用大量尿激酶顺行或全身静脉溶栓治疗。结果：11例患者经7－15d的治疗后症状消失,血栓完全或部分溶解,血管开通,取出临时性腔静脉滤器,未出现并发症及异位栓塞。结论：置入临时性腔静脉滤器在外周静脉血栓患者溶栓治疗中是预防静脉血栓脱落导致异位栓塞的有效方法。     

左髂静脉受压综合征并发下肢深静脉血栓形成的综合介入治疗

目的 探讨介入治疗髂髂静脉受压综合征并发左下肢深静脉血栓形成的临床价值.方法 对28例左髂静脉受压综合征并发左下肢深静脉血栓形成患者采用经颈静脉插管溶栓、左髂静脉球囊扩张及支架治疗,部分血栓已蔓延至下腔静脉的患者在溶栓前行下腔静脉滤器置入.结果 28例患者均在术前彩色多普勒超声检查及术中造影检查明确诊断;5例行可回收性下腔静脉滤器置入,所有患者均经颈静脉置入溶栓导管于髂股静脉进行溶栓治疗,髂股静脉血栓溶解率100%,溶栓后均予以球囊扩张左髂总静脉,其中6例置入髂静脉支架.术后肢体肿胀症状明显减轻或消失,随访3～12个月临床效果满意.结论 采用滤器置入、经颈静脉溶栓、髂静脉球囊扩张及支架治疗左髂静脉受压综合征并发左下肢深静脉血栓形成是一种安全、微创、有效的治疗手段,具有较好的效果,值得临床推广.     

下腔静脉滤器置入术预防致死性肺动脉栓塞：附三例分析

下腔静脉滤器置入术预防下肢深静脉血栓形成后血栓脱落，发生致死性肺动脉栓塞，在欧美等国已得到广泛应用。作者总结了３例下肢深静脉血栓形成后抗凝和／或溶栓治疗无效的病例。男２例，女１例。采用钛质Ｇｒｅｅｎｆｉｅｌｄ下腔静脉滤器，以１２Ｆ直径的输送鞘管置入，滤器置下肾静脉下方的下腔静脉内。２例左髂股静脉血栓形成，经右股静脉置入，１例右侧病变，经左侧进路。随诊１￣１２个月，观察到１例滤器向头端移位０．７ｃｍ     

置管溶栓术治疗下腔静脉滤器内栓子的疗效观察

目的 评价置管溶栓术治疗下腔静脉滤器内栓子的疗效及安全性.方法 2005年1月至2010年12月对31例经造影证实的下腔静脉滤器内存在栓子患者进行置管溶栓术治疗,栓子最大径均超过1 cm,溶栓药物采用尿激酶,用量为每日60万u,疗程为3～7d,术后观察临床疗效及并发症.结果 经置管溶栓治疗,18例栓子消失,7例栓子最大径缩小至3 mm以下,6例无明显变化.并发症有穿刺点渗血5例,血尿3例,腹膜后血肿1例,无严重并发症发生.并发症经对症治疗恢复良好.25枚滤器被成功取出,6枚滤器被留置.滤器取出术中及术后无急性肺栓塞发生.结论 置管溶栓术是治疗下腔静脉滤器内栓子安全、有效的方法,能提高下腔静脉滤器的取出率.     

下肢深静脉血栓介入综合治疗临床效果分析

目的探讨经颈内静脉置管溶栓联合可回收下腔静脉滤器(IVCF)置入术治疗急性下肢深静脉血栓形成(ALEDVT)的临床疗效。方法选取57例ALEDVT患者作为研究对象,所有患者均在DSA引导下经颈内静脉行IVCF置入和下肢深静脉置管溶栓术。间隔1~3天复查造影,根据复查结果调整溶栓导管位置。溶栓治疗后撤除溶栓导管并行IVCF取出术,如伴髂总静脉梗阻,则联合腔内成形术。观察溶栓疗效和并发症情况,比较治疗前后健患侧大腿、小腿周径差和患肢深静脉通畅评分,彩超随访患肢深静脉通畅及瓣膜保存情况。结果57例患者均顺利完成经颈内静脉IVCF置入和置管溶栓术,技术成功率100.0%;治疗期间,所有患者未出现症状性肺栓塞,患肢胀痛缓解;溶栓时间4~15天,平均(8.3±3.0)天,尿激酶用量260~1020万U,平均(440±310)万U。疗效评价显示治愈42例(73.7%)、有效15例(26.3%)、无效0例(0%)。53例(93.0%)患者成功取出IVCF,另有4例(7.0%)放弃取出。无患者出现脑出血、消化道出血等严重并发症,3例(5.3%)出现轻度血尿,减少尿激酶剂量后好转。与溶栓前相比,溶栓后患者健患侧大腿、小腿周径差及静脉通畅评分均有明显改善,差异有统计学意义(P<0.05)。末次随访时,彩超提示患肢深静脉瓣膜保存率为83.3%(40/48),深静脉通畅评分为(3.5±1.8)分。结论经颈内静脉置管溶栓联合可回收IVCF置入术治疗ALEDVT是安全、有效的,可恢复血流、改善症状并预防肺栓塞。     

腔静脉滤器置入并静脉溶栓治疗并发症的观察及护理

目的 探讨腔静脉滤器置入并静脉溶栓治疗并发症的观察及护理方法.方法 2007年7月-2010年3月开展腔静脉滤器置入并静脉溶栓治疗70例,针对主要并发症进行观察,包括出血倾向、肺栓塞、滤器移位、脱落、滤器血栓闭塞、滤器穿破下腔静脉、患肢静脉功能不全及患肢皮肤水疱的观察和护理.结果 70例溶栓治疗的总有效率为95.7%(...     

深静脉血栓形成的诊断和介入治疗

深静脉血栓形成-肺动脉栓塞是目前临床上较为棘手的疾病之一，肺动脉栓塞的病死率较高。肺动脉栓塞主要由深静脉血栓形成引起。近年来受到国内医学界的广泛关注。深静脉血栓形成的主要原因是：局部血流缓慢、血液黏滞度增高和局部静脉管腔狭窄等。深静脉血栓形成的好发部位依次为：下肢、下腔静脉、上肢、锁骨下静脉、上控静脉、肾静脉等。常用的影像检查技术包括：彩色超声、同位素扫描、多普勒血流仪和静脉造影等。深静脉血栓的治疗手段有：抗凝和溶栓治疗、介入溶栓术、负压抽吸术、高压喷射碎栓术、碎栓消融术、球囊扩张成形术、金属内支架植入术和下腔静脉滤器植入术等。介入治疗常见的并发症有“全身或穿刺局部出血，下腔静脉滤器移位、误置，滤器局部血栓形成等，常需及时处理。     

Reconstruction of an inferior vena cava stent occlusion using double-barrel stenting in a patient with Behçet's disease

Symptomatic inferior vena cava (IVC) and iliac vein thrombosis is increasingly being treated with thrombolysis, thrombus retrieval and deep venous stenting. If the IVC stent occludes, endovenous intervention is indicated to restore patency. An 18-year-old male with Behçet''s disease presented with deep vein thrombosis (extending from the IVC to the popliteal segments bilaterally) which was initially treated with thrombolysis and stenting. Fifteen months later, the patient experienced symptomatic deterioration; a chronically-occluded IVC stent was identified and reconstructed using a double-barrel stenting technique. Patient compliance to post-stenting anticoagulation therapy is paramount to maintain stent patency. A multi-disciplinary approach including haematologists can be beneficial for patients with a background of thrombophilic disorders.     

Suprarenal inferior vena cava filter implantation

Purpose

This study evaluated the feasibility, safety, and efficacy of the suprarenal implantation of a retrievable filter in patients with renal cell carcinoma (RCC) and renal vein thrombosis (RVT) [extending or not extending to the inferior vena cava (IVC)] undergoing surgery.

Materials and methods

Between March 2005 and May 2010, 13 patients (eight men and five women; mean age 67.08 years, range 38?C95) with RCC and RVT associated or not with IVC thrombosis underwent implantation of a retrievable suprarenal IVC filter. All patients underwent computed tomography angiography (CTA), which documented RVT and in some cases its extension to the IVC. The level of IVC involvement by the neoplastic thrombus was evaluated on the basis of the Oto classification. Cavography was performed before and after filter implantation. Surgical resection of RCC was performed in all patients. A CTA scan was performed 1 week before filter removal.

Results

The procedure had 100% feasibility. All filters were correctly deployed in the suprarenal tract of the IVC. There was no evidence of peri-or postprocedural complications. All patients were monitored for clinical symptoms of pulmonary embolism (PE). There was no evidence of PE in the 30 days after the procedure. All suprarenal IVC filters were removed from 30 to 60 days after surgery.

Conclusions

Implantation of a temporary suprarenal IVC filter is an additional and feasible procedure that can prevent immediate and perioperative PE.     

经大隐静脉穿刺置管溶栓治疗急性期髂股静脉血栓形成

目的:探讨经大隐静脉入路置管溶栓治疗髂股静脉血栓形成的应用价值。方法:对18例急性期髂股静脉血栓形成的患者在下腔静脉滤器植入术前提下,经大隐静脉入路置管溶栓治疗。结果:18例患者经大隐静脉穿刺成功置管,技术成功率为100%,治疗有效率为100%。置管期间无不良反应及并发症发生;平均住院时间为12.5d。结论:经大隐静脉入路置管溶栓介入治疗急性期髂股静脉血栓操作简便,经济实用,安全有效。     

Filter-related,thrombotic occlusion of the inferior vena cava treated with a Gianturco stent

The authors report a case of complete thrombotic occlusion of the inferior vena cava (IVC), which occurred 4 weeks after placement of an IVC filter (TrapEase; Cordis, Miami FL). Initial treatment with suction thrombectomy and thrombolysis was ineffective. Percutaneous removal of the filter was unsuccessful because of the long period of implantation. TrapEase filters (Cordis) are easily collapsible because of their symmetric design and composition (nitinol). An expandable metallic Gianturco Z stent (Cook, Bloomington, IN) was used to exclude the filter from the vessel lumen. In cases of persistent filter-related, thrombotic occlusion of the IVC, in which initial treatment has failed, the use of a Gianturco stent (Cook) to exclude the filter from the vessel lumen is a viable treatment option if the filter has a collapsible design.     

The Mid-Term Efficacy and Safety of a Permanent Nitinol IVC Filter (TrapEase)

Objective

1) To evaluate the mid-term efficacy and safety of a permanent nitinol inferior vena cava (IVC) filter; 2) to evaluate filter effectiveness, filter stability and caval occlusion.

Materials and Methods

A prospective evaluation of the TrapEase IVC filter was performed on 42 patients (eight men, 34 women) ranging in age from 22 to 78 years (mean age 66 years). All patients were ill with a high risk of pulmonary embolism (PE). Indications for filter placement were: 1) deep vein thrombosis with recurrent thromboembolism; 2) and/or free-floating thrombus with contraindication to anticoagulation; and 3) complications in achieving adequate anticoagulation. Follow-up evaluations (mean: 15.4 months, range: 2 to 28 months) were performed at 6- and 12-month intervals after the procedure and included clinical histories, chart reviews, plain film, Doppler ultrasounds, and contrasted abdominal CT scans.

Results

In follow-up evaluations, the data analysis revealed no cases of symptomatic PE. There were no cases of filter migration, insertion site thrombosis, filter fracture, or vessel wall perforation. During the study, there was one case of filter thrombosis; early symptomatic thrombosis that was successfully treated in the hospital. Of the 42 subjects, eight died. These deaths were not related to the filter device or the implantation procedure, but to the underlying disease.

Conclusion

This study demonstrates that the TrapEase permanent IVC filter is a safe and an effective device with low complication rates and is best used in patients with thromboembolic disease with a high risk of PE.     

置管溶栓治疗下腔静脉血栓：附21例报道

目的探讨置管溶栓（catheter-directed thrombolysis,CDT）治疗下腔静脉血栓的安全性和疗效。 方法回顾性分析21例经CDT治疗的下腔静脉血栓患者的临床及影像资料。 结果21例患者均经静脉造影诊断为下腔静脉血栓,同时伴有下肢深静脉血栓。其中下肢深静脉血栓向上延续导致的下腔静脉血栓18例,下腔静脉滤器导致的下腔静脉血栓3例。21例患者均在下腔静脉滤器的保护下成功进行CDT治疗,其中7例患者伴有髂静脉压迫综合征,给予髂静脉支架治疗。随访3～48个月,1例肿瘤患者CDT术后2周再次出现下肢深静脉血栓,给予加强抗凝治疗后好转,其他患者无血栓复发,所有患者无严重并发症的发生。 结论下肢深静脉血栓和下腔静脉滤器均会导致下腔静脉血栓。在下腔静脉滤器的保护下,CDT治疗下腔静脉血栓是安全有效的方法。     

Role of IVC Filters in Endovenous Therapy for Deep Venous Thrombosis: The FILTER-PEVI (Filter Implantation to Lower Thromboembolic Risk in Percutaneous Endovenous Intervention) Trial

Objectives

The purpose of this study was to evaluate the necessity of and recommend indications for inferior vena cava (IVC) filter implantation during percutaneous endovenous intervention (PEVI) for deep venous thrombosis (DVT).

Background

PEVI has emerged as a powerful tool in the management of acute proximal DVT. Instrumentation of extensive fresh thrombus is potentially associated with iatrogenic pulmonary embolism (PE). The true frequency of this complication has not been studied in a randomized fashion. We evaluated IVC filter implantation during PEVI for DVT.

Methods

A total of 141 patients with symptomatic proximal DVT undergoing PEVI for symptomatic DVT were randomized to receive an IVC filter (70 patients) or no filter (71 patients; control group). The anticoagulation and PEVI regimen were similar between the two groups. Patients with development of symptoms suggestive of PE underwent objective testing for PE.

Results

PE developed in 1 of the 14 symptomatic patients in the filter group and 8 of the 22 patients in the control group (P?=?0.048). There was no mortality in any group. Three patients (4.2%) in the control group had transient hemodynamic instability necessitating resuscitory efforts. Predictors of iatrogenic PE were found to be PE at admission; involvement of two or more adjacent venous segments with acute thrombus; inflammatory form of DVT (severe erythema, edema, pain, and induration); and vein diameter of?≥7?mm with preserved architecture.

Conclusions

IVC filter implantation during PEVI reduces the risk of iatrogenic PE by eightfold without a mortality benefit. A selective approach may be exercised in filter implantation during PEVI.     

Power-pulse thrombolysis and stent recanalization for acute post-liver transplant iliocaval venous thrombosis

Postoperative inferior vena cava (IVC) thrombosis is a potentially lethal complication in a liver transplant recipient. We report the case of a 57-year-old liver transplant recipient, who developed acute, postoperative, markedly symptomatic complete IVC, ilial-femoral-caval, and left renal vein thrombosis. After treatment with power-pulse tissue plasminogen activator thrombolysis, thrombectomy, and stent placement, the IVC and iliac veins were successfully recanalized. At 2.5-year imaging and laboratory follow-up, the IVC, iliac, and renal veins remained patent and graft function was preserved.     

Endovascular recanalization of the thrombosed filter-bearing inferior vena cava

PURPOSE: To evaluate the authors' preliminary experience with use of endovascular methods to treat inferior vena cava (IVC) thrombosis in patients with IVC filters. MATERIALS AND METHODS: Catheter-directed thrombolysis, balloon maceration, mechanical thrombectomy, and stent placement were used to treat 10 patients with thrombosis of filter-bearing IVCs causing symptoms in 18 limbs. Procedural challenges, technical and clinical success, complications, postprocedural filter status, and postprocedural pulmonary embolism (PE) prophylaxis were monitored. RESULTS: Technical and clinical success were achieved in 15 of 18 (83%) and 14 of 18 symptomatic limbs (78%), respectively. Major bleeding (muscular hematoma) occurred in one patient (10%). Postprocedural PE prophylaxis included anticoagulation (n = 8) and placement of a new filter into a newly placed Wallstent (n = 1). During clinical follow-up, no clinically detectable PE was observed. Data pertaining to late limb status were available at a median of 19 months (range 1-46 months) follow-up in seven patients: three patients were asymptomatic, two patients had ambulatory edema only, one patient had constant mild edema, and one patient had constant severe edema. Postprocedural filter stability was radiographically documented at a median of 255 days (range, 4-1021 d) of follow-up. CONCLUSION: Endovascular recanalization of the occluded IVC is feasible even in the presence of an IVC filter.