经皮穿刺大隐静脉下肢静脉造影术的临床应用

目的 探讨经皮穿刺大隐静脉下肢静脉造影术(PGSV)对髂静脉病变和下肢深静脉瓣膜功能检查的可行性和临床应用价值.资料与方法 78例(86条患肢)经皮穿刺大隐静脉注入对比剂进行髂静脉病变和下肢深静脉瓣膜功能的检查,并与经皮穿刺足背浅静脉下肢静脉造影术(PDPV)进行比较.结果 PGSV 的第1、2和3次静脉穿刺成功率分别为36.36%(20/55)、43.64%(24/55)和20.0%(11/55).PGSV对髂静脉的清晰显示明显优于PDPV(P＜0.05).与PGSV相比,PDPV诊断髂静脉受压综合征、股浅静脉第一对瓣膜和隐股静脉瓣膜功能不全的敏感性分别为11.76%、46.67%和59.65%.结论 经皮穿刺大隐静脉下肢静脉造影术具有操作简单、损伤小,可部分替代经皮穿刺股静脉造影术对髂静脉病变和部分下肢深静脉瓣膜功能的检查.     

下肢深静脉造影方法的改进(附33例分析)

目的 :探讨改进下肢深静脉造影方法的可行性。方法 :3 3例 3 9条下肢 ,在深静脉顺行造影明确下肢静脉回流通畅后 ,随即行经皮静脉穿刺插管造影 ,检查每一对股腘静脉瓣膜的功能。结果 :3 8条下肢为原发性深静脉瓣膜功能不全 (PDVI) ,单纯性大隐静脉曲张 1条 ,均属静脉倒流性疾病。深静脉倒流程度 0° 1条、2° 3条、3° 2 1条、4° 14条。结论 :将顺行和经皮腘静脉插管造影合并进行 ,是一次性解决下肢深静脉诊断的可行方法     

下肢静脉造影在下肢静脉疾病诊治过程中的临床意义

目的:探讨下肢静脉造影在下肢静脉疾病诊治过程中的临床意义。方法:本组患者共1696例,对其中2123条下肢行下肢静脉顺行造影,同时行逆行下肢静脉造影452条,对造影表现进行分析。结果:2123条下肢造影成功率为100%。其中正常静脉11条(0.52%),单纯性浅静脉瓣膜关闭不全409条(19.27%),原发性深静脉瓣膜功能不全1120条(52.76%),深静脉血栓形成后综合征302条(14.23%),先天性下肢深静脉瓣膜发育不全症15条(0.71%),深静脉血栓形成65条(3.06%),先天性静脉畸形骨肥大综合征14例条(0.66%),左髂总静脉压迫综合征187条(8.81%)。结论:下肢静脉造影对下肢静脉疾病原发病因的明确诊断、选择恰当的治疗方法以及疗效的观察等具有重要的临床意义和实用价值。     

DSA静脉造影诊断下肢静脉疾病

目的：探讨DSA下肢深静脉造影诊断下肢静脉疾病的价值。方法：56例（66条）下肢静脉病变的患者在DSA下行下肢深静脉顺、逆行造影,其中16例行经皮穿刺腘静脉插管造影。结果：根据主要X线表现将下肢静脉疾病分为：下肢静脉曲张10条（15%）、下肢深静脉瓣膜功能不全34条（52%）和深静脉血栓形成22条（33%）。根据深静脉逆流程度分为：Ⅰ级10条,Ⅱ级14条,Ⅲ级8条,Ⅳ级2条。结论：在DSA下行下肢深静脉造影,能为临床提供可靠的影像学诊断依据,以利治疗方案的选择。     

DSA在下肢深静脉造影中的临床应用

目的 探讨DSA 在下肢深静脉造影中的临床应用.方法 28例(33条)下肢静脉疾病的患者在DSA下行下肢深静脉顺、逆行造影,其中3例行经皮穿刺腘静脉插管造影.结果 根据主要X线表现将下肢静脉疾病分为:单纯性浅静脉瓣膜功能不全5条(15%),交通静脉瓣膜功能不全22条(67%),原发性深静脉瓣膜功能不全17条(52%),深静脉血栓形成8条(24%)和深静脉血栓形成后遗症3条(9%).根据深静脉逆流程度分为:Ⅰ级5条,Ⅱ级7条,Ⅲ级3条,Ⅳ级1条.结论 在DSA下行下肢深静脉造影能清楚地显示病变的部位、形态和范围,为临床治疗方案的选择提供可靠依据,值得推广.     

经皮静脉穿刺插管造影术及其价值(附20例23条肢体分析)

目的：探讨静脉穿刺插管造影术对下肢静脉疾病诊断的价值。方法：２０例２３条肢体行顺行深静脉造影和经皮静脉脉穿刺插管造影检查。结果：技术成功率为１００％。未发生并发症。２３条肢体中深静脉瓣膜功能不全的１４条，其中２条伴有交通静脉瓣膜功能不全。单纯交通静脉瓣膜功能不全１条。大隐静脉近端瓣膜功能不全３条。深静脉血栓形成后遗症２条。深静脉血栓形成２条。静脉瘤样病变１条。基本包括了常见下肢静脉疾病。结论：该法具有易穿刺插管，不易损伤瓣膜的优点。可满意显示髂－股－静脉，并能逐一观察每一对瓣膜的功能，同时也是髂－股－静脉血栓开通治疗的重要途径之一，弥补了其他造影术的不足。     

经皮腘静脉插管造影术的临床应用

作者对37例患者的37条下肢行经皮腘静脉插管造影术,认为此造影不但可以清晰地显示髂—股—腘静脉段。而且能够逐一测试这段静脉中每一对瓣膜的功能,弥补了顺行和逆行造影术的不足。用此方法并能逐一检测双股静脉畸形的每一支,对双股静脉畸形的原发性深静脉瓣膜功能不全做出明确诊断。     

下肢顺行静脉造影在下肢静脉疾病的应用

目的：分析下肢顺行静脉造影结果与临床诊治下肢静脉疾病的应用价值。材料和方法：我院1991－1996年间112例135条下肢,对临床主要表现下肢静脉曲张或伴溃疡,疑为血管瘤患者进行了肢顺静脉造影。结果：造影表现正常26条（19．26％）,深静脉瓣膜功能不全65条（48．15％）,单纯浅脉瓣膜功能不全13条（9．63％）,交通静脉瓣膜功能不全9条（6．66％）,静脉瘤5条（3．7％）,深静脉血栓形成17条（12．6％）。结论：顺行静脉造影是种简便、安全,创伤小效果好,为临床提供准确的诊治住处,可作为诊治下肢静脉疾病的首选方法,给临床血管外科治疗提供有效依据,对海绵状血管瘤需同时配用瘤体直接穿策造影来确诊。     

数字下肢静脉顺行造影的临床应用价值

目的:探讨数字成像结合下肢静脉造影对下肢静脉疾病的X线表现,评价其对临床的应用价值.材料和方法:回顾性分析87例(100侧肢体)下肢深静脉顺行造影的表现.结果:造影表现正常19侧肢体(19%)、单纯性下肢浅静脉瓣膜功能不全6侧肢体(7.4%)、交通静脉瓣膜功能不全9侧肢体(11%)、深静脉瓣膜功能不全49侧肢体(60.5%)、继发性静脉瓣膜功能不全6侧肢体(7.4%)、静脉瘤样改变6侧肢体(7.4%)、深静脉血栓形成6侧肢体(7.4%)和先天性静脉发育异常3侧肢体(3.7%).结论:下肢静脉顺行造影能较清晰地显示下肢静脉病变位置和范围及下肢静脉解剖变异.对明确诊断、选择合适的治疗方法以及疗效的观察等具有重要的临床意义和实用价值.     

数字化顺行性下肢静脉造影的诊断价值

目的用数字化顺行性下肢造影的应用情况,评价其诊断价值。方法采用德国SiemensAx-iomIeonosR200Fleom数字化x线胃肠机对2011年12月至2013年3月158例（172条）下肢进行顺行性静脉造影检查。结果单纯性下肢浅静脉瓣膜关闭功能不全80条（46．5％）,交通静脉瓣膜关闭功能不全12条（7．0％）,深静脉瓣膜关闭功能不全33条（19．8％）,下肢深静脉血栓36条（20．9％）,髂静脉受压综合征5条（2．9％）,静脉畸形骨肥大综合征2条（1．2％）,静脉瘤3条（1．7％）。结论数字化下肢静脉造影是一种安全易行、图像清晰度高、对比度好、分辨率高、检查结果直观、确切的检查方法,能给临床明确诊断及治疗提供可靠的影像诊断依据。     

顺行性下肢深静脉造影表现及临床意义

目的：评价顺行性下肢深静脉造影对下肢静脉疾病诊断、分类及治疗的临床价值。材料与方法：327例病人（447条病肢）采用顺行性下肢深静脉造影，适时点片。结果：原发性深静脉瓣膜功能不全226条（59。5％），深静脉血栓形成后综合征110条（24．6％），原发性浅静脉瓣膜功能不全26条（5．9％），急性深静脉血栓形成23条（5．1％），先天性静脉发育异常13条（2．9％），静脉瘤样病变7条（1．5％）。结论：顺行性下肢深静脉造影对下肢静脉疾病的诊断、分类、治疗有重大指导意义。     

下肢静脉顺行造影(附80侧分析)

目的探讨下肢静脉顺行造影X线表现.方法回顾性分析80侧下肢静脉顺行造影的影像学所见.结果综合影像学所见,将病人分为正常组和异常组;其中异常组分单纯性瓣膜关闭不全4侧,交通静脉瓣膜关闭不全6侧,原发性下肢深静脉瓣膜关闭不全32侧,继发性下肢深静脉瓣膜关闭不全5侧,血栓形成3侧,先天性下肢静脉发育异常2侧,静脉瘤样或弥漫血管湖5侧.结论下肢静脉顺行造影作为一种简便易行的检查手段在下肢静脉疾病的诊断中具有独特的应用价值.     

二维及彩色多普勒血流显像诊断下肢静脉病变的意义

目的 评价彩色多普勒血流显像检测临床下肢静脉病变的应用价值。方法 对临床下肢静脉病变90例107条下肢静脉进行彩色多普勒血流显像检查。结果 彩色多普勒血流显像可迅速清晰地显示下肢的解剖图像，其中检出61例64条下肢静脉有血栓形成（急性血栓31例，慢性血栓30例），8例9条深静脉瓣功能不全，31例34条为下肢静脉曲张。结论 下肢深静脉血栓形成有一定的声像特征，彩色多普勒血流显像检出敏感性高，可对血栓作出定位，定范围和管腔阻塞程度的判断，是帮助临床选择治疗方案和客观评价药物疗效的重要方法。判断有无深静脉功能不全，可为临床手术和治疗提供可靠依据。     

Symptomatic lower extremity deep venous thrombosis: accuracy, limitations, and role of color duplex flow imaging in diagnosis

Color duplex flow imaging (CDFI) permits pain- and risk-free direct imaging of the deep venous system of the lower extremities. To prospectively ascertain the accuracy and limitations of this technique, CDFI was performed in 75 lower limbs of 69 consecutive patients referred for venographic evaluation of clinically suspected lower extremity deep venous thrombosis (DVT). The CDFI study was obtained within 24 hours of the contrast venogram. Both studies were interpreted without knowledge of the patient's clinical findings or the results of the other test. Contrast venography was regarded as the standard for diagnosis of DVT. Accuracy was 99% for detection of DVT above the knee and 81% below the knee. Sonographic evaluation of the calf veins was technically adequate in 60% of limbs; accuracy was 98% in this group. In the 40% of limbs with technically limited CDFI studies of the calf, accuracy decreased to 57%. Although small nonocclusive thrombi occurred infrequently in this series of symptomatic patients, CDFI missed three of four such thrombi. It is concluded that CDFI, when not technically compromised, is sufficiently accurate to definitively diagnose symptomatic lower extremity DVT.     

Deep venous thrombosis evaluation with limited-flip-angle, gradient- refocused MR imaging: preliminary experience

Sixteen patients (17 lower extremities) were prospectively examined with venography and limited-flip-angle, gradient-refocused magnetic resonance (MR) imaging for the presence or absence of deep venous thrombosis. Thrombosed vessels showed decreased-to-absent signal intensity, while patent vessels had high signal intensity. In 16 of 17 extremities, MR images allowed accurate detection and localization of the thrombi found with venography. In the remaining extremity, MR imaging allowed correct identification of thrombus in the iliac and femoral veins but incorrectly demonstrated clot in the calf and popliteal veins. MR imaging with limited-flip-angle, gradient-refocused pulse sequences appears to be a sensitive, noninvasive means of detecting deep venous thrombosis.     

Using dual-detector helical CT angiography to detect deep venous thrombosis in patients with suspicion of pulmonary embolism: diagnostic value and additional findings

OBJECTIVE: The purpose of this study was to assess the value of dual-slice helical CT angiography in detecting deep venous thrombosis in patients in whom acute pulmonary embolism was suspected and to describe the additional extrathoracic findings. SUBJECTS AND METHODS: Sixty-five consecutive patients were examined for suspected pulmonary embolism using helical CT of the chest (2.7-mm collimation; table speed, 7.5 mm/sec; 100-140 mL of contrast medium injected at a rate of 3 mL/sec) followed by CT of the lower limbs (6.5-mm collimation; table speed, 10 mm/sec) without any additional contrast medium injection. Sequential scanning of the abdomen was performed using 10-mm collimation and an interval of 40 mm. Color Doppler sonography of the lower limbs was done within 24 hr of CT by two radiologists who were unaware of CT findings. Results of CT venography were compared with those of Doppler sonography and with phlebography or repeated focalized sonography in cases of discrepancy. RESULTS: Twenty-two patients had pulmonary embolism revealed on chest CT. Sixteen patients had a deep venous thrombosis. Thirteen patients with pulmonary embolism had a deep venous thrombosis. Three patients with deep venous thrombosis had no pulmonary embolism. Sensitivity and specificity for diagnosing deep venous thrombosis with CT was 93% and 97%, respectively (kappa = 0.88). Additional extrathoracic findings were observed in four patients. CONCLUSION: Combined CT venography with dual-slice scanning is an accurate method to diagnose deep venous thrombosis that may reveal additional imaging findings in some patients with possible pulmonary embolism.     

内窥镜下静脉交通支断离术联合Muller术治疗下肢静脉曲张

目的探讨内窥镜下静脉交通支断离术（SEPS）联合Muller术治疗下肢静脉曲张的可行性。方法2005年9月～2006年3月,经静脉顺行造影诊断下肢静脉交通支瓣膜功能不全患肢41条,随机选择31条患肢（Ⅰ组）行SEPS术,在深筋膜下断离病变交通支,联合Muller术抽剥浅表曲张静脉,保留健康大隐静脉。另10条患肢（Ⅱ组）行传统大隐静脉抽剥术。结果Ⅰ组曲张静脉团块消失,下肢静脉血淤滞得到缓解,色素沉着减轻,溃疡愈合,随访5～11个月无复发。与Ⅱ组相比,Ⅰ组手术时间平均缩短1．5h,缝合创口平均减少4.3个,住院时间平均缩短4．8天,差异有显著意义（P〈0．01）。结论SEPS联合Muller术适合个体化微创治疗下肢静脉曲张,创伤小,恢复快。     

Evaluation of the lower extremity veins in patients with suspected pulmonary embolism: a retrospective comparison of helical CT venography and sonography. 2000 ARRS Executive Council Award I. American Roentgen Ray Society

OBJECTIVE: In patients undergoing a combined CT angiographic and CT venographic protocol, the accuracy of helical CT venography for the detection of deep venous thrombosis was compared with that of lower extremity sonography. MATERIALS AND METHODS: Patients who had undergone a combined CT angiographic and CT venographic protocol and sonography of the lower extremities within 1 week were identified. The final reports were evaluated for the presence or absence of deep venous thrombosis. Statistical measures for the identification of deep venous thrombosis with helical CT venography were calculated. In each true-positive case, the location of the thrombus identified with both techniques was compared. All false-positive and false-negative cases were reviewed to identify the reasons for the discrepancies. RESULTS: Seventy-four patients were included. There were eight patients (11%) with true-positive findings, 61 patients (82%) with true-negative findings, four patients (5%) with false-positive findings, and one patient (1%) with a false-negative finding. When comparing helical CT venography with sonography for the detection of lower extremity deep venous thrombosis, the sensitivity measured 89%; specificity, 94%; positive predictive value, 67%; negative predictive value, 98%; and accuracy, 93%. Of the eight true-positive cases, five had sites of thrombus that were in agreement on both CT venography and sonography. Of the five discordant cases, four were false-positives and one was a false-negative. Possible explanations for all discrepancies were identified. CONCLUSION: Compared with sonography, CT venography had a 93% accuracy in identifying deep venous thrombosis. However, the positive predictive value of only 67% for CT venography suggests that sonography should be used to confirm the presence of isolated deep venous thrombosis before anticoagulation is initiated. In addition, interpretation of CT venography should be performed with knowledge of certain pitfalls.     

99Tcm-大颗粒聚合白蛋白显像在下肢深静脉血栓中的诊断价值

目的 探讨99Tcm-大颗粒聚合白蛋白( 99Tcm-M AA)核素深静脉显像(RNV)对下肢深静脉血栓(DVT)的诊断价值.方法 临床疑似下肢DVT的患者45例,均行99Tcm-MAA双下肢RNV,并与临床最终诊断结果进行对照.结果 43例共51条患肢经临床确诊,51条血栓性患肢中,左下肢36条、右下肢15条,左下患...     

下肢远端静脉动脉化治疗缺血性糖尿病足

目的：探讨缺血性糖尿病足的治疗.方法：对26例（29肢）腘动脉以下广泛性闭塞或狭窄,采用膝关节下静脉动脉化,7肢为近端动脉重建后远端静脉动脉化.其中浅静脉型11（大隐静脉6,大隐＋小隐3,小隐2）肢,深静脉型18（胫腓干12,胫后3,胫腓静脉成形后3）肢.结果：经3月～10年随访,除2肢半足截肢外,均保存了肢体功能.结论：该手术对肢体缺血症状解除快,对静脉回流影响小,可分期完成也可一期完成,适应证广.