超声引导下顺行静脉穿刺一站式治疗血栓性髂静脉压迫综合征的临床探讨

目的探讨超声引导下顺行静脉穿刺联合AngioJet血栓抽吸导管及髂静脉支架植入术一站式治疗血栓性髂静脉压迫综合征的临床应用体会。方法回顾性分析2018-06~2020-01入住该科确诊的血栓性髂静脉压迫综合征的患者16例,所有患者均在下腔静脉滤器的保护下采用超声引导下顺行穿刺左下肢腘静脉或小隐静脉建立通路,采用AngioJet血栓清除技术后置入溶栓导管,一期或二期植入髂静脉支架。结果16例血栓性髂静脉压迫综合征患者中有11例患者选择左侧腘静脉穿刺,5例患者选择左侧小隐静脉穿刺,穿刺成功率为100.00%,平均抽吸量为(178.20±14.20)ml,技术成功率为100.00%,尿激酶用量为(150.59±60.92)万U。7例患者一期植入髂静脉支架,9例患者为溶栓后植入髂静脉支架,血栓清除率Ⅲ级患者13例,血栓清除率Ⅱ级患者3例。无致命性出血、症状性肺栓塞等严重并发症发生。结论超声引导下顺行左下肢静脉穿刺联合AngioJet血栓抽吸导管及髂静脉支架可以为血栓性髂静脉压迫综合征患者提供一站式解决方案,简化手术流程,提高手术成功率;同时可提高远期效果,降低远期血栓形成后综合征的发生。

A clinical practice of anterograde venipuncture for one-stop treatment of thrombotic iliac vein compression syndrome under ultrasound guidance

Objective To explore the clinical application of ultrasound-guided antegrade venipuncture combined with AngioJet thrombus suction catheter and iliac vein stent implantation in one-stop treatment of thrombotic iliac vein compression syndrome.Methods A retrospective analysis was made on 16 patients with thrombotic iliac vein compression syndrome admitted to our department from June 2018 to January 2020.Under the protection of inferior vena cava filter,ultrasound-guided anterograde venipuncture of popliteal vein or saphenous vein of left lower extremity was used to establish a pathway.After AngioJet thrombectomy,thrombolytic catheter was inserted,and iliac vein stent was implanted in PhaseⅠor PhaseⅡ.Results Among the 16 patients with thrombotic iliac vein compression syndrome,11 patients received left popliteal vein puncture,and 5 patients received left small saphenous vein puncture.The puncture success rate and the technical success rate were 100.00%.The average suction volume was(178.20±14.20)ml,and the urokinase dosage was(150.59±60.92)million U.7 patients were implanted with iliac vein stents in PhaseⅠ,and 9 patients were implanted with iliac vein stents after thrombolysis.13 patients were in gradeⅢthrombus clearance rate,and 3 patients in gradeⅡthrombus clearance rate.No serious complications such as fatal bleeding and symptomatic pulmonary embolism occurred.Conclusion Ultrasound-guided anterograde left lower extremity venipuncture combined with AngioJet thrombus suction catheter and iliac vein stent can provide a one-stop solution for patients with thrombotic iliac vein compression syndrome,simplify the operation process and improve the success rate of the operation,and can improve the long-term effect and reduce the incidence of long-term post-thrombotic syndrome.