Long-term follow-up results of the iliofemoral venous thrombosis.

During the past 7 years 116 patients with acute and chronic iliofemoral venous thrombosis were treated surgically and medically. Exploration was undertaken mainly by clinical assessment and routine venography for follow-up was not considered as a requisite. Thrombectomy was performed 18 times in 17 patients with excellent or good results in 66.6%. Palma's operation was carried out 17 times in 17 patients with satisfactory results in 82.3%. These were contrasted with 34.2% satisfactory results among the medical patients. These lead to the following conclusion: 1. Venous thrombectomy within 14 days after the onset is effective. 2. The usefulness of delayed thrombectomy is uncertain. 3. Palma's operation offers satisfactory results for chronic iliofemoral venous thrombosis. 4. In Japan, in contrast with America and Europe, pulmonary thromboembolism is exceedingly rare and ligation or interruption of the inferior vena cava or the femoral vein is not performed routinely.     

Catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis

Patients with acute iliofemoral deep venous thrombosis often experience severe postthrombotic complications that result from venous obstruction and valve incompetence. Conventional anticoagulation prevents thrombus extension, fatal pulmonary embolism, and recurrence of the deep venous thrombosis, but it can hardly minimize the postthrombotic complications. Whether early thrombus removal significantly reduces the postthrombotic morbidity is an important question related to the treatment of these patients. This article will chiefly introduce rationale for and evidence supporting early thrombus removal for acute iliofemoral deep venous thrombosis, and the development and current status of catheter-directed thrombolysis and adjunctive percutaneous mechanical thrombectomy or pharmacomechanical thrombolysis, which are usually the first line of therapy for early removal of an acute thrombus in the proximal veins of the leg. In addition, we will briefly introduce the development of new pharmacologic agents.     

机械性血栓抽吸术治疗髂股静脉血栓形成

目的:探讨机械性血栓抽吸治疗髂股静脉血栓形成的临床疗效。方法:回顾性分析236例急性髂股深静脉血栓(DVT)患者的临床资料。均经健侧股静脉预防性放置下腔静脉滤器,在数字减影血管造影(DSA)透视下患侧股静脉插入12～14 F大腔鞘管,50 mL注射器负压抽吸髂股静脉血栓。112例合并髂静脉狭窄或闭塞患者,行经皮血管成形术(PTA)和支架植入;术后给予肝素抗凝。结果:出院时膝上、下15 cm处健、患侧周径差分别降为(1.34±0.57)cm和(0.93±0.42)cm,与入院时比较差异有统计学意义(t=19.37、23.99,P均<0.05);随访36个月,随访率97.88%(231/236)。术后水肿、色素沉着和溃疡等后遗症发生率12.99%(30/231)、8.23%(19/231)和0;随访疗效优92.21%(213/231)。支架植入患者随访均通畅。结论:机械性血栓抽吸治疗髂股DVT疗效显著,并发症少,住院周期短,能够明显降低后遗症的发生率。     

Treatment of acute iliofemoral deep venous thrombosis: a strategy of thrombus removal.

Patients with acute iliofemoral deep vein thrombosis (DVT) suffer the most severe postthrombotic sequelae. The majority of physicians treat all patients with acute DVT with anticoagulation alone, despite evidence that postthrombotic chronic venous insufficiency, leg ulceration, and venous claudication are common in patients treated only with anticoagulation. The body of evidence to date in patients with iliofemoral DVT suggests that a strategy of thrombus removal offers these patients the best long-term outcome. Unfortunately, currently published guidelines use outdated experiences to recommend against the use of techniques designed to remove thrombus, ignoring recent clinical studies showing significant benefit in patients who have thrombus eliminated. Contemporary venous thrombectomy, intrathrombus catheter-directed thrombolysis, and pharmacomechanical thrombolysis are all options that can be offered to successfully remove venous thrombus with increasing safety. The authors review evidence supporting the rationale for thrombus removal and discuss the most effective approaches for treating patients with acute iliofemoral DVT.     

Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life

PURPOSE: Treatment designed to eliminate thrombus in patients with iliofemoral deep venous thrombosis (DVT) is theoretically attractive; however, its benefits, compared with those of anticoagulation, have not been definitively demonstrated. Although not previously analyzed, an effective measure of treatment success is likely to be the assessment of health-related quality of life (HRQOL). This study evaluated whether catheter-directed thrombolysis for iliofemoral DVT is associated with improved HRQOL, compared with standard anticoagulation, and whether HRQOL outcome in the thrombolysis group is related to lytic success. METHODS: An 80-item self-administered HRQOL questionnaire was developed. It contained the Health Utilities Index, Short Form-12, and disease-targeted scales, including health distress, stigma, health interference, physical functioning, and symptoms (eg, leg swelling, pain, ulcers). The HRQOL questionnaire was confirmed to be reliable and valid by means of psychometric testing. Questionnaires were administered to 98 retrospectively identified patients who had had iliofemoral DVT treated at least 6 months earlier. Sixty-eight patients who were identified through a DVT registry were treated with catheter-directed thrombolysis with urokinase (UK), and 30 patients who were identified by means of a medical record review were treated with anticoagulation alone. The treatment decision was made by the attending physician, and all patients were candidates for both thrombolysis and anticoagulation. RESULTS: Most patients were women (61%), white (95%), married (65%), and had a mean interval since initial DVT of 16 months. The group treated with UK was younger (53 +/- 17 years) than the group treated with heparin (61 +/- 6 years; P =.039). After treatment, patients treated with UK reported better overall physical functioning (P =.046), less stigma (P =.033), less health distress (P =.022), and fewer post-thrombotic symptoms (P =. 006), compared with the patients treated with anticoagulation alone. Within the UK group, phlebographically successful lysis correlated with improved HRQOL (P =.038). Patients classified as lytic failures had similar outcomes to patients treated with heparin. CONCLUSION: Patients with iliofemoral DVT treated with catheter-directed thrombolysis have better functioning and well-being, compared with patients treated with anticoagulation alone. Successful lysis was directly correlated with improved HRQOL, with patients who were classified as lytic failures having similar outcomes to patients treated with heparin. These data support the need for a future randomized trial, which should include an HRQOL measure as part of the outcome analysis.     

腔内综合治疗髂股静脉血栓形成

目的:探讨腔内治疗急性髂股静脉血栓形成的临床疗效。方法:回顾性分析2013年1月―2015年1月64例行腔内综合治疗的急性髂股静脉血栓形成患者临床资料。结果:患者经下腔静脉滤器保护下置管溶栓术治疗后,新鲜血栓均得到有效溶解,无严重溶栓并发症发生;13例(13/64)患者发现髂静脉狭窄严重,下肢肿胀缓解不明显,同期行球囊扩张,其中5例(5/64)二期造影发现侧支血管代偿不佳、髂静脉狭窄50%,行二期支架植入。经腔内综合治疗,患者的双下肢膝上15 cm周径差较术前明显缩小(3.87 cm vs.7.56 cm,P0.05);随访期间无再发下肢肿胀、髂股静脉狭窄及支架内血栓形成,无下肢色素沉着及溃疡形成,无肺动脉栓塞及死亡病例。结论:腔内综合治疗急性髂股静脉血栓形成安全、有效,对清除血栓、解除狭窄实现管腔再通效果良好。     

手术取栓与药物溶栓治疗急性髂股型下肢深静脉血栓形成的疗效比较

目的 评估手术取栓加药物溶栓与单纯药物溶栓治疗急性髂股型下肢深静脉血栓形成的疗效.方法 回顾性分析175例髂股型下肢深静脉血栓形成患者的临床资料,依据治疗方式的不同分为取栓组与溶栓组;手术取栓组85例,其中合并髂总静脉狭窄或闭塞的46例,选择于术或介入治疗,术后给予尿激酶、低分子肝素治疗.采取药物溶栓抗凝治疗90例,仪给予尿激酶、低分子肝素治疗.治疗前两组患者年龄、病程、肿胀程度及伴随疾病比较,差异无统计学意义(P＜0.05).结果 治疗后1个月,手术取栓组治愈率71.8%(61/85),双下肢周径差手术组由(4.6±1.6)cm下降为(0.8±0.5)cm;溶栓组治愈率38.9%(35/90);双下肢周径差由(4.0±1.9)cm下降为(1.8±1.3)cm.平均随访(28±11)个月,随访率64.6%,治疗后12个月,双下肢周径差手术组下降为(0.4±0.3)cm,溶栓组下降为(0.9±0.7)cm,手术组治愈率86.0%(49/57),溶栓组治愈率53.6%(30/56);手术组的下肢深静脉血栓形成后遗症发生率低于溶栓组(P＜0.05),手术组的静脉瓣功能异常的发生率低于溶栓组(P＜0.05).结论 急性髂股型下肢深静脉血栓形成手术取栓加溶栓疗效优于单纯药物溶栓.     

全膝关节置换术后深静脉血栓发生的中期随访研究

目的探讨全膝关节置换术(TKA)后深静脉血栓(DVT)发生情况的中期随访结果。方法2003年7月～2004年3月对59例患者(68膝)行TKA,其中获得随访者55例(63膝)。术后1、2周使用临床症状观察、多普勒超声检查和深静脉造影评定DVT。每6个月门诊随访一次,主要进行DVT临床症状和手术侧下肢多普勒超声检查；对症状严重者行深静脉造影,并对其结果加以总结。结果术后1周,静脉造影确诊为DVT者34例(61．8%)41膝；术后2周,12例血栓消失,2例血栓向近端扩散。所有患者获平均36．6个月(32～40个月)随访,术后6、12、18、24、30个月时DVT的发生率差异无显著性意义(P＞0．05)。结论无论围手术期是否存在DVT,中期DVT的发生率并无差异。     

Symptomatic venous hypertension because of occult iliofemoral deep vein thrombosis: a report of two cases.

Two 25-year-old males with symptomatic venous hypertension (venous claudication, n = 1; swollen leg, n = 1) were evaluated for iliofemoral venous occlusive disease. One patient had a common femoral vein/external iliac vein occlusion with no history of deep vein thrombosis or trauma. The second patient had an acute deep vein thrombosis superimposed on a chronic external iliac vein stenosis. No source of extrinsic venous compression was identified in either patient. Venous reconstruction with vein bypass (patient no. 1) and vein patch angioplasty (patient no. 2) led to resolution of their hypertensive symptoms. Intraoperative examination of the involved vein segments revealed chronic changes consistent with a prior occult deep vein thrombosis in both patients. Occult iliofemoral deep vein thrombosis in young healthy males is rarely seen. The acute deep vein thrombosis may manifest minimal or no symptoms but it can lead to chronic venous occlusive disease and serious post-phlebitic morbidity. In this context, these two cases are discussed with a review of the pertinent literature.     

Results of surgical treatment for iliofemoral venous thrombosis

The long-term results after venous thrombectomy combined with a temporary arteriovenous fistula were evaluated in 19 patients. Clinical status, isotope phlebography, venous occlusion plethysmography and foot volumetry were performed after a mean follow-up time of 38 months (range 13-75). The primary operation was successful in 17 of the 19 patients; the 2 remaining had chronic occlusions of their iliac veins. At the time of closure of the arteriovenous fistula, i.e. 3 months after thrombectomy, 14 patients had a patent iliac vein. At follow-up eight patients were considered to have a patent iliac vein, eight had a partial restitution and three had an occluded iliac vein. The group as a whole had no impaired venous emptying of the leg, but the small group of patients with occlusion at follow-up according to isotope phlebography seemed to have an impaired venous emptying. Foot volumetry showed only minor signs of valvular insufficiency, mainly in limbs with distal extension of the initial thrombus or only partial restitution of venous patency. A good long-term result can be expected after venous thrombectomy with a temporary arteriovenous fistula particularly in younger patients where the thrombosis is limited to the iliofemoral segment. This emphasizes the importance of early operation before distal extension of the thrombus occurs.     

Evolution of deep venous thrombosis: a 2-year follow-up using duplex ultrasound scan and strain-gauge plethysmography

OBJECTIVE: The development of the post-thrombotic syndrome (PTS) and recurrence of deep venous thrombosis (DVT) are not yet fully understood. The aim of the study was to identify factors that lead to the long-term complications of DVT. METHODS: In a 2-year prospective follow-up study, duplex scanning and strain-gauge plethysmography were used to evaluate DVT in relation to the development of long-term complications. Each of the 12 segments examined was assigned as a thrombosis score (TS). A total TS was calculated for each leg. Patent segments were assigned a TS = 0, noncompressible vein segments with flow TS = 1 and noncompressible vein segments without flow TS = 2. The degree of resolution of DVT and the incidence, timing, and outcome of further thrombotic events were measured during 24 months of follow-up. RESULTS: The study involved 86 legs with DVT. The 2-year follow-up was completed for 70 legs. Within 3 months, only 1% of the originally occluded proximal deep vein segments were still occluded. Between all time intervals, from month 12 to month 24, for example, thrombus regression continued in 36% of the legs and thrombus propagation continued in 27%. Multiple regression analysis revealed that an increase in age (P = .008) and proximal location of the original DVT (P = .05) was significantly related to thrombus propagation. Multiple regression analysis showed that the risk factors for clinical signs of PTS were a high venous outflow resistance after 1-month and 12-month follow-ups (P 相似文献   

重组人尿激酶原经导管溶栓治疗急性髂股深静脉血栓的疗效观察

目的：观察重组人尿激酶原（rhPro-UK）经导管溶栓（CDT）治疗急性髂股深静脉血栓（DVT）的临床疗效和不良反应。 方法：回顾性分析2016年10月—2018年12月行CDT治疗的66例急性髂股DVT患者临床资料,其中33例采用rhPro-UK行CDT治疗（观察组）,33例采用尿激酶（UK）行CDT治疗（对照组）。比较两组患者的相关临床指标。 结果：两组患者一般临床特征差异无统计学意义（均P>0.05）。观察组血栓溶解率（≥50%）明显高于对照组（81.8% vs. 60.6%,χ2=4.889,P<0.05）,但在出院时两组的治疗有效率无统计学差异（81.8% vs. 75.7%,χ2=4.889,P>0.05）。两组患者均无明显出血、过敏等并发症。 结论：rhPro-UK和UK都是治疗急性髂股DVT安全有效的溶栓药物,rhPro-UK在血栓溶解率方面明显优于UK,但其远期疗效需进一步评估。     

Free-floating deep venous thrombosis. A retrospective analysis.

Duplex scan to diagnose deep venous thrombosis is an established technique. As experience accumulated, patients with free-floating thrombi were identified. A retrospective review of 65 patients was performed to study these thrombi, to evaluate treatment regimens, and to analyze patient outcome. A 26% incidence of pulmonary embolus occurred. However patients who had bilateral free-floating thrombi had a 42.8% incidence of pulmonary embolus. Receiving a 7-day course of heparin therapy with a partial thromboplastin time (PTT) at 1.5 times control was 53.2% of patients; 55.4% of the patients underwent follow-up examination, and the mean time to clot attachment was 9.2 days. Patients should receive anticoagulation for 10 days or until clot attachment. Patients with persistent, bilateral free-floating thrombi, or propagation of thrombus are candidates for potential caval interruption. Serial scans should be performed to monitor the thrombus for attachment or alteration.     

Re-evaluation of thrombectomy in the management of iliofemoral venous thrombosis.

The authors studied 15 patients with iliofemoral venous thrombosis up to 8 years after the diagnosis was made, to determine whether there was late deterioration in venous function following thrombectomy. Twelve patients were treated by venous thrombectomy and anticoagulants and 3 by anticoagulants alone. Eight of the 12 patients subjected to thrombectomy had an excellent result with limbs that were considered normal. This did not confirm earlier reports which indicated that good early results were not maintained. In 4 of the 12 surgically treated patients minor symptoms of leg pain and swelling were present which also did not progress with time. In all patients treated by anticoagulants alone major symptoms of leg pain and severe swelling persisted. Three of the four patients with persistent minor symptoms after venous thrombectomy were found at operation to have left iliac vein compression syndrome. Only one of eight patients having an excellent clinical result had this syndrome.