髂静脉支架在急性下肢深静脉血栓形成伴髂静脉压迫综合征患者中的应用

目的 探讨下肢深静脉血栓形成(DVT)伴髂静脉压迫综合征(IVCS)患者血栓清除术后行髂静脉支架治疗的效果。方法 回顾性分析潍坊市人民医院2016年1月至2019年12月收治的83例急性下肢DVT伴IVCS、行血栓清除术患者的临床资料,其中单纯药物治疗组32例,支架治疗组51例。观察2组患者出院时肢体消肿率,术后6、12个月静脉通畅率及Villalta评分。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用t检验、χ²检验或Fisher确切概率检验进行组间比较。结果 单纯药物治疗组大腿与小腿消肿率分别为(29.75±11.74)%和(30.40±10.79)%,支架治疗组分别为(64.35±12.67)%和(61.0±18.89)%;单纯药物治疗组术后6、12个月静脉通畅率分别为87.50%和75.00%,支架治疗组分别为96.07%和92.15%;单纯药物治疗组术后6、12个月Villalta评分分别为(8.16±1.80)和(7.44±1.50),支架治疗组分别为(6.76±2.40)和(6.17±2.11);2组比较,差异均有统计学意义(P＜0.05)。结论 下肢DVT伴IVCS患者血栓清除术后一期行髂静脉支架治疗能显著提高静脉通畅率,改善下肢症状。     

腘静脉置管溶栓联合髂静脉球囊扩张支架植入术治疗合并Cockett综合征的DVT

目的观察腘静脉置管溶栓联合髂静脉球囊扩张支架置入术治疗合并Cockett综合征的下肢深静脉血栓形成的疗效。方法 41例合并Cockett综合征的下肢深静脉血栓形成患者,在下腔静脉滤器保护下行腘静脉置管溶栓联合髂静脉球囊扩张,22例行髂静脉支架植入术。结果本组均无手术后死亡者,无肺动脉栓塞发生。术后3～5 d患者肢体肿胀开始消退,术后5～10 d肿胀明显消退。静脉造影示下肢静脉血栓溶解,少数残存短段血管壁毛糙。38例获随访23例下肢深静脉主干通畅、瓣膜形态良好;11例深静脉不完全通畅、瓣膜形态模糊,未发现支架移位和变形;4例髂静脉支架内血栓形成。结论腘静脉置管溶栓联合髂静脉球囊扩张支架植入术治疗合并Cockett综合征的下肢深静脉血栓疗效满意。     

髂静脉支架在下肢深静脉血栓形成治疗中的应用

目的评价髂静脉支架在急性期下肢深静脉血栓形成伴有髂静脉狭窄或者闭塞的治疗中的应用效果。方法回顾性分析2016年1月至2018年1月山东省潍坊市人民医院收治并行腔内治疗的急性下肢深静脉血栓形成伴髂静脉狭窄或闭塞患者80例。根据手术是否行髂静脉支架植入治疗,分为观察组45例和对照组35例。观察组通过置入下腔静脉滤器+导管接触性溶栓(CDT)+髂静脉支架治疗;对照组采用置入下腔静脉滤器+CDT治疗。对比2组患者术后效果、患肢消肿率、静脉通畅率分别为及流行病学和经济研究-生活质量/症状(VEINES-QOL/SYM)问卷调查评分。采用SPSS 18.0统计软件进行统计分析。结果术前,2组大腿、小腿周径差比较,差异均无统计学意义(均P>0.05);术后,2组大腿、小腿周径差及消肿率比较,差异均有统计学意义(均P<0.05)。随访1、3、6、12个月后,观察组静脉通畅率分别为45例(100.0%)、43例(95.5%)、41例(91.1%)及41例(91.1%),对照组分别为29例(82.8%)、27例(77.1%)、26例(74.2%)及25例(71.4%),差异均有统计学意义(均P<0.05)。观察组与对照组的下肢深静脉血栓后遗症发生率分别为0(0.00%)与4例(11.43%),差异有统计学意义(P<0.05)。观察组与对照组的DVT复发率分别为4例(8.89%)与5例(14.28%),差异无统计学意义(P>0.05)。治疗前,2组患者VEINES-QOL/SYM评分比较,差异均无统计学意义(均P>0.05);治疗后,2组患者VEINES-QOL/SYM评分比较,差异均有统计学意义(均P<0.05)。结论髂静脉支架在急性期下肢深静脉血栓形成伴有髂静脉狭窄或者闭塞的治疗中的应用效果优于单纯置管溶栓。     

经导管溶栓治疗下肢深静脉血栓经验初探

目的:分析经导管溶栓治疗下肢深静脉血栓的治疗效果。方法:2009年1月至2010年10月,北京协和医院血管外科,共对20例急性下肢深静脉血栓患者进行导管溶栓治疗,根据患者血栓部位和发病时间,选择同期20例抗凝治疗患者进行配对对照研究。观察时间点为术后即刻、6个月和12个月。使用血管开通评分方法来评价目标血管的开通情况。同时,观察溶栓组和抗凝组的出血等重大不良事件。结果:溶栓组和抗凝组的一般资料基本相当,累计髂静脉的病例均为15例(75%),发病1～3 d的急性血栓均为10例(50%),4～7 d为6例(30%)。抗凝组的平均年龄显著高于溶栓组。溶栓组的平均溶栓时间(79.2±28.1)h,使用尿激酶平均(343±70.0)万单位,2例患者因尿激酶使用后D-二聚体上升不明显,另外使用了重组组织型纤溶酶原激活物(r-tPA)100 mg。住院期间、术后6个月、12个月的血管开通评分,溶栓组均显著优于抗凝组。溶栓组有3例大出血事件,抗凝组有1例出血事件,2组之间差异无统计学意义。结论:对于急性下肢深静脉血栓,选择合适的病例进行经导管溶栓可以获得满意的近期和中期效果,对于溶栓导致的出血事件应有充分的预案处理。     

下腔静脉滤器联合导管溶栓治疗急性下肢深静脉血栓的疗效观察

目的探讨下腔静脉滤器联合导管溶栓治疗急性下肢深静脉血栓的疗效和临床应用。方法入选2013年2月至2015年8月广州医科大学附属第一医院连续收治的17例下肢深静脉血栓患者,其中混合型血栓15例,中央型2例;16例血栓位于左侧深静脉,1例血栓位于右侧深静脉。所有患者均经健侧股静脉插管置入滤器后,将溶栓导管置入患侧下肢静脉进行尿激酶溶栓,期间定期复查下肢深静脉造影及下肢静脉超声。结果所有患者均一次性成功置入OptEase下腔静脉滤器并成功进行尿激酶溶栓治疗,患者临床症状在溶栓5~10 d后均明显改善及消失,其中7例溶栓后下肢静脉造影左髂总静脉狭窄大于90%;5例经球囊扩张后残余狭窄小于40%;2例球囊扩张后残余狭窄大于50%,并行支架置入术,术后残余狭窄小于20%。结论下腔静脉滤器联合导管溶栓治疗急性下肢深静脉血栓安全、直接、有效,但长期疗效有待于进一步观察。     

左髂静脉压迫并发急性髂股静脉血栓形成综合治疗临床分析

目的:探索左髂静脉压迫并发急性髂股静脉血栓形成的综合治疗方案,并评价其临床效果和安全性。方法:回顾性分析2016年1月至2018年2月,我科收治32例左髂静脉压迫并发急性髂股静脉血栓患者。根据治疗效果将其分为Ⅰ到Ⅴ级。术后随访1,6,12个月和24个月行CTV。评估静脉血流通畅情况,支架断裂受压及通畅情况。根据Villalta评分标准评估血栓后综合征及分级。在综合治疗方案中,选择电话、门诊或住院进行血管超声及血管造影或者下肢CTV的方法进行随访,观察下肢深静脉通畅率,肢体肿胀情况等并发症发生情况。结果:随访1～24个月,髂静脉支架通畅率为100%,其中3例为支架内附壁血栓,支架内血流仍通畅,术后下肢遗留轻度肿胀,均能耐受。术后左下肢肿胀症状均快速减轻或消失,造影显示左股静脉至髂静脉血栓基本完全消除,下肢血管CTV检查示:髂静脉支架均通畅,随访3～24个月临床疗效满意。32例患者术后均恢复静脉血流,治疗效果评价:Ⅰ级28例,Ⅱ级4例,无Ⅲ～Ⅴ级。所有患者术后下肢肿胀症状均缓解,无围手术期出血、肺栓塞等并发症及死亡。平均随访8个月(1～24个月),下肢静脉均血流通畅,无复发,3例患者于6个月后出现轻度血栓后综合征。结论:综合治疗方案可以明显增加减溶效果,缩短溶栓药物用量和使用时间,减少出血并发症,同时显著减少血栓后综合征发生率。     

胫后静脉置管溶栓治疗急性下肢深静脉血栓形成的疗效观察

目的 观察胫后静脉置管溶栓治疗急性下肢深静脉血栓形成(DVT)的临床疗效.方法 选择37例急性DVT患者,在超声引导下经患肢胫后静脉穿刺,置入溶栓导管至髂、股、腘静脉血栓进行溶栓治疗,并分析其临床疗效.结果 溶栓治疗后,患者患、健侧大腿及小腿周径差均明显小于溶栓前(P均＜0.01);患肢大腿消肿率为(89.74±7.16)％,小腿消肿率为(86.74±7.57)％.溶栓后静脉通畅评分明显高于溶栓前(P＜0.01),溶栓后静脉平均通畅率为(75.34±7.36)％.患者均未发生严重并发症.对33例患者随访5～12个月,均无血栓再发.结论 胫后静脉置管溶栓是治疗急性DVT安全、有效的方法.     

胫前静脉入路导管接触性溶栓治疗急性下肢深静脉血栓形成的临床疗效观察

［摘要］　目的　观察胫前静脉入路导管接触性溶栓（CDT）治疗急性下肢深静脉血栓形成（DVT）的临床疗效。方法　选择阜阳市第二人民医院2019年1月至2020年3月拟行胫前静脉入路CDT治疗急性下肢DVT患者43例（发病在1周以内）。比较患者治疗前后健患侧下肢周径差。观察患者治疗后并发症发生情况及临床疗效。结果　经胫前静脉入路置管成功39例（90.70%）。患者术后穿刺部位无出血并发症发生，轻度疼痛5例，麻木不适3例。32例术后随访时间3～12个月，随访期间症状消失，无血栓复发及肺栓塞发生。治疗后，患者健患侧下肢周径差显著减小（P<0.05）；静脉通畅评分为(3.29±0.91)分，较治疗前的(8.47±1.09)分下降，差异有统计学意义（t=19.475，P=0.000）；平均静脉通畅率为（57.24±11.57）%；瓣膜保存率达84.38%（27/32）。结论　胫前静脉入路CDT治疗急性下肢DVT临床疗效好，手术并发症少，值得临床推广应用。     

手术与导管溶栓综合治疗急性下肢深静脉血栓形成(附138例报告)

对138例急性下肢深静脉血栓患者行手术取栓,术中留置导管,术后每天经导管行溶栓治疗.结果平均置管5 d.留置导管静脉造影示120例患肢深静脉全程通畅,静脉壁光滑无反流,5例胭静脉狭窄50%,10例胫前静脉部分再通,3例胫后静脉部分再通.随访86 d～5 a,118例症状全部消失,2例穿弹力袜能正常工作.认为手术取栓联合导管溶栓治疗急性下肢深静脉血栓形成疗效肯定,可减少下肢深静脉血栓形成等后遗症.     

经导管局部溶栓治疗下肢深静脉血栓形成38例临床观察

目的观察经导管局部直接溶栓治疗下肢深静脉血栓形成的疗效。方法38例下肢深静脉血栓形成患者,在置入腔静脉滤器后,经胭静脉置入溶栓导管局部直接溶栓,共10—14d。结果髂股静脉完全再通率73．68％（28／38）,临床治愈率73．68％（28／38）,总有效率100％;未发生肺栓塞及出血并发症。结论经导管局部直接溶栓治疗下肢深静脉血栓形成,髂股静脉再通率高且安全。     

下肢深静脉血栓介入治疗观察与护理

目的观察我院下肢深静脉血栓介入治疗的效果,并对其实施的护理模式进行探析。方法选取我院2012年1月至2013年12月期间收治的46例下肢深静脉血栓的患者为研究对象。将其分为两组,即试验组与对照组。两组患者均采用相同的治疗方法进行治疗,其中对照组患者在治疗的过程中采用传统的护理模式,而试验组患者在对照组的基础上实施综合护理干预。对比两组患者的临床效果,主要包括:护理满意度、患者治疗前后不良情绪评分等。结果试验组患者对护理的总满意率为95.65%,对照组患者对护理的总满意率为69.57%。试验组患者的护理满意程度要高于对照组患者,两组患者比较情况具有统计学差异(P0.05)。同时护理后试验组患者的不良情绪评分要优于对照组患者,两组患者比较情况具有统计学差异(P0.05)。结论通过加强基础护理,注重心理护理、健康教育以及病情观察,对下肢深静脉血栓介入治疗患者恢复起到重要作用。     

Comparison of four clinical prediction scores for the diagnosis of lower limb deep venous thrombosis in outpatients

PURPOSE: We compared three scores for the prediction of deep venous thrombosis with a new score designed specifically for outpatients. METHODS: Patients referred for evaluation because of suspected deep venous thrombosis were examined by ultrasonography. Sensitivity and specificity were calculated for three clinical scores (Wells [nine components], Kahn [four components], and St. André [six components]). We developed a new score by multivariate analysis, and then compared this score with the others in a new sample. RESULTS: Four hundred and forty-four outpatients were included in the first sample, of whom 126 (28%) had deep venous thrombosis. The Wells score was a better predictor of deep venous thrombosis than the Kahn and St. André scores. According to the Wells score, 73 patients had a high probability of deep venous thrombosis (of whom 51 [70%] actually had a thrombosis) and 178 had a low probability of deep venous thrombosis (of whom 19 [11%] had a thrombosis). A new score was developed as follows: male sex (+1), lower limb palsy or immobilization (+1), confinement to bed >3 days (+1), lower limb enlargement (+1), unilateral lower limb pain (+1), and other plausible diagnosis (-1). In a validation sample of 282 outpatients, this score identified 31 patients who had a high probability of deep venous thrombosis (score > or =3), of whom 18 (58%) had a thrombosis, and 70 patients who had a low probability (score < or =0), of whom 3 (4%) had a thrombosis. The Wells score and this ambulatory score had similar test operating characteristics in the validation sample. CONCLUSION: Our new six-component score had similar diagnostic utility as the nine-component Wells score among outpatients being evaluated for deep venous thrombosis.     

Incidence and risk factors for bilateral deep venous thrombosis of the lower limbs

The incidence of bilateral deep venous thrombosis in patients with single limb or bilateral symptoms was determined using duplex scan examination. In a prospective study, 157 inpatients with clinical suspicion of deep venous thrombosis underwent duplex scan evaluation of the lower extremities. Demographic characteristics, physical examination data, and risk factor information were collected. In all, 57 (36.3%) patients evaluated presented echographic evidence of acute deep venous thrombosis. Forty-six individuals presented unilateral thrombosis, and 11 patients presented bilateral disease (19.3% of all thrombosis, 7.0% of all patients). Sensitivity and specificity of clinical examination in identifying bilateral thrombosis was 27.2% and 93.3%, respectively. For the risk factors evaluated, active human immunodeficiency virus disease and iliofemoral thrombosis presented an increased risk for bilateral thrombosis (P = .045 and P = .049, respectively). The high incidence of bilateral deep venous thrombosis justifies bilateral duplex scan examination. Active human immunodeficiency virus disease and proximal thrombosis were risk factors for bilateral disease.     

替罗非班在下肢深静脉血栓介入治疗中的应用

目的:探讨下肢深静脉血栓介入治疗中形成急性血栓,应用新型抗血小板药物替罗非班的临床价值。方法:在下腔静脉滤器保护下,急性下肢深静脉血栓形成患者行介入综合治疗,术中6例患者均在血流再通后发生静脉内急性新鲜血栓,静脉推注替罗非班负荷量8-10 ml,并8 ml／h维持48 h。结果:静脉内推注替罗非班10-30 min后重复造影显示血栓消失,术后所有患者症状明显改善,预后良好,无严重并发症发生。结论:替罗非班对深静脉血栓介入治疗过程中形成急性血栓有良好的疗效。     

下肢静脉造影对老年人下肢静脉疾病的诊断价值

目的探讨下肢静脉造影对老年人下肢静脉疾病的诊断价值及老年人下肢静脉疾病的特点。方法对36例疑有下肢静脉疾病、年龄≥60岁的老年人进行常规或数字减影下肢静脉造影。根据造影表现进行分析。结果36例老年病例共55侧肢体下肢静脉造影均获成功,其中54侧为阳性。根据X线表现分类:静脉阻塞性病变30侧(54.5%),静脉逆流性病变23侧(41.8%),静脉瘤样病变1侧(1.8%)。深静脉血栓形成及形成后再通为主要表现。结论下肢静脉造影对老年人下肢静脉疾病的诊断及分类具有重要价值。本组病例中老年人下肢静脉疾病以下肢静脉阻塞性疾病居多。     

Prevalence of venous thromboembolism in neurosurgical patients

This study was conducted to clarify the prevalence of venous thromboembolism (VTE) in neurosurgical patients. Prospective study for venous thromboembolism screening after neurosurgery was conducted. Thirty-seven patients were screened by ultrasonography for deep vein thrombosis in the lower extremities at an average of 12 days postoperatively. All patients received standard thromboprophylaxis using graded compression stocking with/without intermittent pneumatic compression following the VTE prevention guidelines. Definitive diagnosis of venous thromboembolism was made by contrast-enhanced whole-body computed tomography. Prevalence of deep vein thrombosis of the lower legs was 13.5% (5/37). Incidence of pulmonary embolism was 60% (3/5) in patients having deep vein thrombosis. All patients having venous thromboembolism were asymptomatic. In high-risk patients, VTE prevalence after neurosurgery was high even under mechanical prophylaxis. Additional pharmacological prophylaxis should be considered for patients with high risk of VTE.     

Treatment and Outcomes of Acute Pulmonary Embolism and Deep Venous Thrombosis: The CVRN VTE Study

BackgroundFew studies describe both inpatient and outpatient treatment and outcomes of patients with acute venous thromboembolism in the United States.MethodsA multi-institutional cohort of patients diagnosed with confirmed pulmonary embolism or deep venous thrombosis during the years 2004 through 2010 was established from 4 large, US-based integrated health care delivery systems. Computerized databases were accessed and medical records reviewed to collect information on patient demographics, clinical risk factors, initial antithrombotic treatment, and vital status. Multivariable Cox regression models were used to estimate the risk of death at 90 days.ResultsThe cohort comprised 5497 adults with acute venous thromboembolism. Pulmonary embolism was predominantly managed in the hospital setting (95.0%), while 54.5% of patients with lower extremity thrombosis were treated as outpatients. Anticoagulant treatment differed according to thromboembolism type: 2688 patients (92.8%) with pulmonary embolism and 1625 patients (86.9%) with lower extremity thrombosis were discharged on anticoagulants, compared with 286 patients (80.1%) with upper extremity thrombosis and 69 (54.8%) patients with other thrombosis. While 4.5% of patients died during the index episode, 15.4% died within 90 days. Pulmonary embolism was associated with a higher 90-day death risk than lower extremity thrombosis (adjusted hazard ratio 1.23; 95% confidence interval, 1.04-1.47), as was not being discharged on anticoagulants (adjusted hazard ratio 5.56; 95% confidence interval, 4.76-6.67).ConclusionsIn this multicenter, community-based study of patients with acute venous thromboembolism, anticoagulant treatment and outcomes varied by thromboembolism type. Although case fatality during the acute episode was relatively low, 15.4% of people with thromboembolism died within 90 days of the index diagnosis.     

心脏永久起搏器置入术后上肢深静脉血栓的发生率及治疗经验

目的总结心脏永久性起搏器置入后上肢深静脉血栓的发生情况及治疗经验。方法302例心脏永久起搏器置入术后或行起搏器更换手术的患者,采用彩色血流和频谱多普勒超声方法,部分患者行患侧上肢静脉造影检查,探查患者上肢深静脉血栓形成情况,门诊随访至术后6～12个月。结果上肢深静脉血栓组和无血栓组在年龄、性别、病史,植入电极导线数量,抗血小板/抗凝治疗情况等临床资料无差异。随访中发生上肢深静脉血栓形成,静脉狭窄、闭塞45例,发生率14.9%,无患者发生血栓脱落栓塞事件,其中有症状的患者14例,占31.1%,均有不同程度患侧上肢肿胀、疼痛、肤色变深,有的患者活动明显受限,出现时间于术后3天～1年,检查提示为新鲜血栓,经尿激酶溶栓、低分子肝素、华法林抗凝治疗以及抗血小板治疗后,患者症状均明显改善,治疗3个月后超声显示血栓消失。无症状者31例,占68.9%,28例(90.3%)为陈旧性血栓,侧枝循环丰富;余3例为新鲜血栓。结论心脏永久起搏器术后上肢深静脉血栓形成是常见并发症之一,术后应密切观察,定期随访。对上肢深静脉血栓形成患者,给予华法林维持治疗3个月是必须和有效的。     

Relationship between genetic polymorphism of MTHFR C677T and lower extremities deep venous thrombosis

Objective: To investigate the association between the polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene and the formation of lower extremities deep venous thrombosis, and to evaluate the etiology of deep venous thrombosis.

Methods: Polymorphisms of the 677th site C/T in MTHFR gene for 101 patients with lower extremities deep venous thrombosis (DVT group) and 120 healthy subjects (control group) were detected by polymerase chain reaction with sequence-specific primers. Genotype and allelic frequencies were compared between the two groups.

Results: Genotype frequencies of CC, CT and TT in MTHFR C677?T were 41.58, 25.74 and 32.67% in DVT group, and 58.33, 23.33 and 18.33% in control group, respectively. There was a significant difference in TT genotype frequency between the two groups (P <0.05).

Conclusion: The frequency of MTHFR 677TT genotype may be correlated with the morbility of DVT.     

Assessment of acute and old deep venous thrombosis in upper extremity by venous strain gauge plethysmography.

The purposes of this study were to evaluate the efficiency of occlusion strain gauge plethysmography in the diagnosis of symptomatic deep venous thrombosis in upper extremities, to compare early (one month) and late clinical evolution (many years) to plethysmography data and, finally, to set up normal and pathological values. Four groups of patients were tested. Sixteen patients with confirmed acute thrombosis, 6 patients with unconfirmed thrombosis, 15 with an old thrombosis (mean follow-up: 7 years) as well as 15 healthy volunteers. The outflows measurements were significantly lowered (p less than 0.05) in the arms with acute thrombosis compared to the contralateral arms, to the affected arms of patients with thrombosis excluded and to both volunteers' arms. Pathological values for the different outflow parameters could be defined as follows: Maximum venous output less than 110 ml/100 ml/minute, Outflow after 3 seconds less than 1.2 ml/100 ml, Strandness index less than 0.16. On month after the acute episode we found a good correlation between the usually favourable clinical evolution and venous haemodynamics assessed by plethysmography. The mild late post-thrombotic syndrome of most patients with an old thrombosis was not well demonstrated by plethysmography.