髂静脉受压综合征并下肢深静脉血栓形成的综合性腔内治疗

目的：探讨综合性腔内治疗髂静脉受压综合征合并下肢深静脉血栓形成的临床效果。 方法：选取2004年10月—2012年10月，315例髂静脉压迫综合征合并急性下肢深静脉血栓形成患者，左侧277例，右侧38例。均行局麻下患侧股静脉穿刺，并在导丝引导下，采用12~14 F鞘管机械性血栓抽吸或配合Fogarty球囊取栓，对髂静脉狭窄或闭塞病变行血管成形术或支架植入，术后根据血栓清除情况，行抗凝或置管溶栓治疗。 结果：患肢肿胀、疼痛均于术后1~2 d内开始消退或减轻。血栓清除III级（清除率>95%）80.32%、II级（清除率50%~95%）18.09%、I级（清除率<50%）1.59%。支架植入后，治愈86.03%、显效10.79%、好转2.54%、无效0.64%。出院时健、患肢膝上、下15 cm处周径差均小于入院时（均P<0.05）。随访通畅率分别为3~6个月95.87%，7~12个月95.53%，13~24个月94.25%，25~36个月92.33%。 结论：综合性腔内治疗髂静脉受压综合征合并下肢深静脉血栓形成，疗效显著、恢复时间短，是安全有效的方法。

Integrated endovascular therapy for iliac vein compression syndrome with deep vein thrombosis

Objective: To investigate the clinical efficacy of integrated endovascular therapy for iliac vein compression syndrome (IVCS) with secondary deep vein thrombosis (DVT). Methods: From October 2004 to October 2012, 315 patients with IVCS and DVT were enrolled, with left leg involvement in 277 cases and right leg involvement in 38 cases. All patients underwent ipsilateral femoral vein puncture under local anesthesia, a 12- to 14-F sheath was inserted via a guidewire, and then mechanical thrombus aspiration or additional embolectomy with Fogarty balloon was performed, and the iliac vein stenosis or occlusion was treated with angioplasty or stent placement. Patients received anticoagulation therapy or/and catheter-directed thrombolysis after operation according to the degree of thrombus removal. Results: The swelling and pain in all the affected legs was alleviated 1-2 d after operation. Thrombus removal of grade III (removal rate greater than 95%) was 80.32%, grade II (removal rate between 50% and 95%) was 18.09%, and grade I (removal rate less than 50%) was 1.59%. The results of stent placement showed that 86.03% were excellent, 10.79% good, 2.54% improved and 0.64% unimproved. The differences between the leg circumference of the normal and affected extremities at 15 cm above and below the knee joint at time of discharge were all less than those at admission (both P<0.05). The follow up patency rate at 3-6 months was 95.87%, 7-12 months was 95.53%, 13-24 months was 94.25%, and 25-36 months was 92.33%, respectively. Conclusion: Integrated endovascular therapy for IVCS with DVT has demonstrable efficacy with fast recovery, so it is an effective and safe treatment method.