血管腔内治疗下肢深静脉血栓形成

目的 探讨下肢深静脉血栓的介入联合手术的血管腔内治疗方法.方法 76例下肢深静脉血栓形成的患者,在数字减影血管造影术(digtal subtraction angiography,DSA)监视下行下腔静脉滤器置入,采用手术取栓,辅以临时性股动静脉瘘,取栓后即刻造影观察有无血栓残留及髂静脉病变情况.残留血栓在DSA监视下用双腔取栓管取栓或大的鞘管吸栓.对髂静脉狭窄大于60%的患者予以血管成形术,其中62例置入髂静脉支架.结果 支架置入技术成功率100%,1例死于腰升静脉破裂出血.71例患者得到随访,其中髂静脉支架患者60例,随访3～30个月,平均随访21个月.65例下肢肿胀明显缓解,发现血栓复发6例(8.45%,6/71)其中支架内血栓形成4例(6.66%,4/60),支架移位6例(10.0%,6/60),支架断裂1例(1.66%,1/60).结论 在DSA监视下,取栓联合髂静脉支架置入可提高取栓后静脉通畅率,是治疗下肢深静脉血栓的重要方法.

Endovascular treatment of lower extremity deep venous thrombosis

Objective To evaluate the endovascular treatment of deep venous thrombosis (DVT)by surgery combined with intervention.Method This study enrolled 76 patients with lower extremity deep venous thrombosis.Under the surveillance of DSA(digital subtraction angiography),inferior vena cava filter was first placed,then surgical thrombectomy,combined with a temporary femoral artery and vein fistula were performed accordingly.Angiography was followed immediately to observe whether there were residual thrombosis and iliac vein lesions.For the removal of residual thrombus,double-lumen tube thrombectomy or large bore sheath suck thrombectomy were applied.In cases in which iliac vein stenosis was greater than 60%,an angioplasty is indicated,in which iliac vein stent placement was performed in 62 cases.ResultStent implantation technical success rate was 100% ,one patient died of rupture of ascending lumbar vein.71 patients were followed up,in which 60 patients with iliac vein stent.After a follow-up of 3-30 months (averaged at 21 months),lower limb swelling significantly eased in 65 patients.Six cases suffered from recurrent thrombosis (8.45%,6/71) in which thrombosis found in the stent in 4 cases (6.66%,4/60),stent displacement found in 6 cases (10.0%,6/60),stent fracture in 1 case (1.66%,1/60).Conclusion Under the surveillance of DSA,thrombectomy combined with iliac vein stent improves vein patency rate,which is the mainstay of the treatment for lower extremity deep venous thrombosis.