超声对下腔静脉滤器远期预防效果的评估作用

目的：探讨彩色多普勒超声（CDUS）对下腔静脉滤器置入术后远期预防效果评估的价值。方法：对45例下肢血栓形成后,行下腔静脉滤器置入术,再利用彩色多普勒超声进行随访观察的病人进行回顾性总结分析。结果：下腔静脉滤器置入术后,患者随访8月,其中13例滤器处有俘获栓子,无1例行下腔静脉滤器置入（IVCFI）术后患者发生滤器变形、移位、倾斜等。临床上未发现1例肺血栓栓塞,有1例患者滤器置入半月后健侧下肢发生深静脉血栓并延伸至下腔静脉（IVC）下段。彩色多普勒超声能准确、经济、快速的诊断静脉血栓的发生,确定发生的平面及范围、回声,反应血栓的新旧、血流通过的情况,清楚的显示下腔静脉滤器的位置以及状态,很大程度帮助临床判定滤器的远期预防效果。结论：彩色多普勒超声能对下腔静脉滤器置入术后下肢静脉血栓形成、病变范围、下腔静脉滤器的位置以及状态作出准确的判断,对临床IVCFI术后远期预防效果评估具有重要作用。     

彩色多普勒超声与数字减影血管造影对比评价不同节段下肢深静脉血栓的诊断价值

目的 探讨彩色多普勒超声对不同节段深静脉血栓形成(DVT)的诊断价值.方法 临床疑为DVT患者58例,应用彩色多普勒超声探测患肢各节段血管,检查结果 与DSA对照,按照四格表分析,评价彩色多普勒超卢诊断不同节段DVT的灵敏性、特异性、准确性等指标.结果 共检测150条不同节段静脉.进行四格表统计分析彩色多普勒超声对各节段血管的检出率:髂总静脉血栓检查灵敏性82.6%,特异性66.7%;髂外静脉血栓灵敏性83.3%,特异性80.0%;髂内静脉血栓灵敏性80.0%,特异性66.7%;胴静脉血栓灵敏性92.6%,特异性92.2%;股静脉血栓灵敏性96.2%,特异性93.8%;胫前静脉血栓灵敏性71.4%,特异性75.0%;胫后静脉血栓灵敏性72.7%,特异性75.0%.结论 彩色多普勒超声作为DVT的首选检查方法 ,对不同节段静脉血栓有不同的诊断价值,对股、胭及髂外静脉灵敏性较高,胫前、胫后静脉血栓检出的灵敏性较低.     

彩超引导下经皮穿刺下腔静脉滤器置入术临床应用研究

目的：探讨彩超引导下经皮穿刺下腔静脉滤器临床应用价值。方法：回顾性分析2009年6月—2013年10月完成的23例彩超引导下经皮穿刺下腔静脉滤器置入患者的资料。结果：所有23例下腔静脉滤器置入术均获得成功。随访过程中,患者未发生滤器移位或并发症,术前出现肺栓塞者,术后未再发生肺栓塞。结论：彩超引导下经皮穿刺下腔静脉滤器置入术可有效预防由下肢深静脉血栓导致的肺栓塞的发生,较X线引导下滤器置入术具有：无X线辐射,费用低廉,对于危重不宜搬动患者可行床边引导,对肾功能不全及对造影剂过敏患者可施行手术等优点。该手术具有较高临床应用价值,易于在基层医院普及推广。     

导管取栓及导管接触性溶栓治疗急性下肢深静脉血栓的疗效及其影响因素

目的:分析导管取栓和（或）导管接触性溶栓治疗急性下肢深静脉血栓（DVT）形成的疗效及影响因素。方法：113例急性下肢DVT患者接受导管取栓和（或）导管接触性溶栓,其中68例接受导管取栓及导管接触性溶栓治疗,45例接受导管接触性溶栓治疗,分析其临床治疗效果。结果：113例患者手术全部获得成功,临床治疗效果满意,静脉通畅率显著提高（64.19%±13.58%）。治疗过程中出现泌尿系出血1例,消化道出血1例,股静脉穿刺区出血2例,经治疗或有效处理后均好转,未出现其它严重并发症。结论：导管取栓及导管接触性溶栓是治疗急性下肢深静脉血栓的安全可靠的方法。对影响手术成功的各因素进行分析、改进可提高手术成功率及安全性,减少并发症。     

后天性肢体动静脉瘘治疗前后超声评价

目的探讨后天性肢体动静脉瘘(AVF)治疗前后彩色多普勒超声评价的临床价值。方法后天性AVF患者治疗前行超声及数字减影血管造影术(DSA)检查,依据超声及DSA检查结果分别对AVF瘘口分型,治疗后应用彩色多普勒超声复查并进行评价。结果本组AVF共31例,其中腋动脉1例、肱动脉3例、桡动脉3例、尺动脉1例、掌动脉2例,股总动脉9例、股浅动脉6例、腘动脉3例、胫前动脉2例、胫后动脉1例;所有病例均只有1个瘘口。二维超声显示24例瘘口内径为2~6 mm,平均(3.9±2.6)mm,7例在二维图像上未见到明显瘘口,但瘘口近端动静脉均有扩张。二维图像上显示12例见瘘口、瘘管及其旁血管呈动脉瘤或假性动脉瘤样改变。本研究中所有病例彩色多普勒超声均显示出动静脉间有异常分流血流信号,根据彩色多普勒超声结果分型:Ⅰ型10例,Ⅱ型9例,Ⅲ型12例,其中Ⅲa型3例、Ⅲb型7例、Ⅲc型2例。超声检查和术前或术中DSA对肢体AVF分型一致性很好(Kappa=0.957)。9例超声引导下弹力绷带局部加压包扎法保守治疗,10例介入治疗,12例手术切开治疗,多次复查彩色多普勒超声未见明显分流血流信号,提示瘘口闭合,治疗效果良好。结论彩色多普勒超声对后天性肢体AVF的诊断、分型及疗效评价有较好的应用价值,可作为首选及必要的影像学方法。     

彩色超声多普勒引导下放置下腔静脉滤器

目的 探讨在彩色超声引导下行下腔静脉滤器(vena eava filter，VCF)置入术的可行性。方法 2001年7月～2003年11月安贞医院血管外科在彩色超声多普勒引导下放置永久性VCF11例。术前均经彩色超声确诊下肢深静脉血栓(deep vein thrombosis，DVT)。术中应用彩超定位，将VCF确切的放置于平肾静脉开口之下的下腔静脉。术后常规肝素和华法令抗凝。结果 本组均获成功。术后7～26月随访，无肺栓塞(pulmonary embolism，PE)发生，无VCF相关并发症出现。结论 不利于搬动的重症患者适合在床旁用此种方法放置VCF。在术前胃肠道准备是必要的。彩超确定下腔静脉和施放VCF的静脉通路无血栓形成，测量下腔静脉直径，明确肾静脉于下腔静脉开口的位置是保证手术成功的关键。彩超引导下行VCF置入术是可行的和方便的，但是还需要同其它方法进行更进一步的比较，以验证其安全性。     

彩色多普勒超声诊断下肢深静脉血栓

目的与深静脉造影相比,探讨彩色多普勒超声对下肢深静脉血栓(DVT)的诊断价值。方法对80例临床疑诊下肢DVT患者行彩色多普勒超声与深静脉造影检查,对比分析检查结果。结果 80例可疑深静脉血栓患者中,彩色多普勒超声诊断65例下肢DVT,深静脉造影诊断64例;一致性检验显示两种方法的一致性好(Kappa值=0.80)。彩色多普勒超声诊断DVT的敏感度为96.88%(62/64),特异度为81.25%(13/16)。结论彩色多普勒超声诊断DVT具有较高的敏感度和特异度,可与深静脉造影相结合,作为诊断DVT的首选影像学方法。     

彩色多普勒超声引导下腔静脉滤器置入术的可行性研究

目的探讨超声引导下经皮穿刺下腔静脉滤器置人(IVCFI)术的可行性、安全性和临床应用价值.方法在彩色多普勒超声(CDFI)引导下,对连续收治的67例下肢深静脉血栓患者行经皮穿刺IVCFI术.结果67例患者术前经CDFI扫查,下腔静脉、肾静脉及其最低入口显示清晰,下腔静脉平均内径20 mm(17～22mm),无变异和血栓,符合所选滤器置入要求.在CDFI引导下,置入VenaTech永久型滤器64只,临时性滤器3只,其中经右股静脉置入39只,左股静脉置入25只,右颈内静脉3只.术后CDFI和X线腹部平片均证实滤器置入位置正确,张开完全,无并发症,技术成功率为100%.随访结果:栓子俘获率37%,滤器无变形和移位,局部无血栓形成,也无滤器置入后PE临床病例发生.结论超声引导经皮穿刺IVCFI术是安全、可靠、简便易行、无污染、费用低廉的实用方法.     

提高彩色多普勒超声诊断下肢深静脉血栓效率的策略研究

目的探讨下肢深静脉血栓形成风险因素、临床表现和血浆D-二聚体水平在彩色多普勒超声诊断下肢深静脉血栓中的协助作用,以提高彩色多普勒超声诊断下肢深静脉血栓的效率.方法解放军总医院2010年1月至2012年1月怀疑下肢深静脉血栓疾病患者2821例,住院患者1602例,门诊患者1219例;所有患者中,确诊为下肢深静脉血栓者1233例.记录所有患者病史、下肢症状和体征且均行下肢静脉超声检查;对住院患者每周行D-二聚体检测,每2周行下肢静脉超声检查,如下肢出现肿胀、疼痛等症状或D-二聚体测值大于标准值(0.5 mg/L),即随时行下肢静脉超声检查.结果1233例下肢深静脉血栓患者中,1097例为第1次超声检查即发现;699例为门诊超声检查时发现,534例为住院后超声检查发现;明确发病因素者954例,未能明确发病因素者279例.住院患者中,403例80岁以下血浆D-二聚体测值小于0.5 mg/L者均无血栓,115例80岁及以上血浆D-二聚体测值1.98μg/ml以下者均无血栓.435例有明确发病因素和99例无明确发病因素患者之间的血浆D-二聚体水平差异无统计学意义[2.58(1.23,5.76) mg/L vs 1.86(0.98,5.23) mg/L,U=1.786,P=0.642].结论了解细致的病史和临床表现有助于提高超声检查的效率;提供确切的下肢深静脉血栓超声表现有利于临床选择治疗方案;不同年龄段D-二聚体水平临界值需作调整,可作为重要的排除诊断下肢深静脉血栓形成的筛选手段,优化超声诊断流程.     

彩色多普勒超声在下肢静脉病变中的诊断效率与误诊分析

目的评价彩色多普勒显像(CDI)对不同节段下肢静脉血栓、侧支循环形成及瓣膜功能不全的诊断效率。方法将80例患者90条静脉分为髂静脉段、股-腘静脉段、胫-腓静脉段共270个节段,并与X线静脉造影对照,分析CDI对各节段静脉血栓、侧支循环形成及瓣膜功能不全的诊断效率,分析漏、误诊原因。结果 CDI诊断髂静脉段、股-腘静脉段、胫-腓静脉段深静脉血栓、侧支循环形成、瓣膜功能不全的敏感度分别为83.33%(20/24)、94.59%(35/37)、77.78%(21/27)、66.67%(8/12)、84.09%(37/44);特异度分别为76.47%(13/17)、94.34%(50/53)、90.48%(57/63)、93.59%(73/78)、91.30%(42/46);准确率分别为80.49%(33/41)、94.44%(85/90)、77.78%(78/90)、90.00%(81/90)、87.78%(79/90);阳性预测值分别为83.33%(20/24)、92.11%(35/38)、86.67%(21/27)、61.54%(8/13)、90.24%(37/41)。髂静脉段血栓漏、误诊8条,股-腘静脉段血栓漏、误诊5条,均为急性、部分栓塞。胫-腓静脉段血栓漏、误诊12条,11例为急性、完全栓塞,1例为慢性、部分栓塞。结论 CDI诊断股-腘静脉段血栓的敏感度、特异度高于髂静脉、胫-腓静脉段。尽管CDI对侧支循环形成的敏感度和阳性预测值较低,但特异度和准确度较高。急性栓塞较易造成漏、误诊。     

The bedside insertion of inferior vena cava filters using ultrasound guidance

Since the introduction of inferior vena cava (IVC) filters more than 30 years ago, there has been a steady improvement in the design, ease, and safety of the delivery systems. Today, all of the commonly used filters can be placed via a peripheral vein by using standard percutaneous Seldinger technique. However, this typically requires fluoroscopy, intravenous contrast agents, radiation exposure, and transport of the patient to the interventional or operating suite. In the multiply injured trauma or critically-ill intensive care unit patient, often requiring inotropic and ventilator support, transport to these facilities can be hazardous. In addition, these patients frequently have a combination of neurospinal and long bone injuries, which require skeletal immobilization, thus further complicating transportation. Advancing technology with portable duplex ultrasound and improved deep abdominal duplex imaging has allowed for routine diagnostic evaluation of the IVC, renal veins, and surrounding visceral structures. This degree of accuracy has allowed numerous centers to gain experience with ultrasonic imaging of the IVC and insertion site after a filter has been placed. A logical progression has evolved to the point in which, today, duplex ultrasound can be used to guide the insertion of IVC filters. The following describes, in detail, a technique for the percutaneous placement of an IVC filter at the bedside using only duplex ultrasound guidance. The article also briefly compares and contrasts this technique with an alternate technique using intravascular ultrasound. Vena caval interruption can be safely performed under ultrasound guidance in a monitored, intensive care unit environment. In selected intensive care unit or multiply injured trauma patients, this will reduce the risk, complexity and cost of transport for these critically ill patients. Duplex-guided IVC filter placement also reduces procedural costs compared to an operating room or interventional suite, and eliminates intravenous contrast material exposure.     

经大隐静脉置入下腔静脉滤器的临床应用

目的探讨经大隐静脉置入下腔静脉滤器（IVCF）的安全性和可行性。方法将有IVCF 置入指征的60例单侧下肢深静脉血栓形成患者随机分成经股静脉组（30例）和经大隐静脉组（30例）,分别经股静脉穿刺和大隐静脉切开置入IVCF,比较两组患者的手术时间、切口长度、术后住院时间及并发症情况。结果两组60例患者均成功实施IVCF置入,无围手术期死亡患者。大隐静脉组手术时间与股静脉组比较,差异无统计学意义（t=0.29,P＞0.05）,大隐静脉组手术切口长度长于腔静脉组,差异有统计学意义（t=-24.70,P＜0.05）,术后下床活动时间、术后住院时间均较股静脉短,差异均有统计学意义（t分别=35.04、3.30,P均＜0.05）。大隐静脉组术后发生并发症例数和穿刺口点血肿明显少于股静脉组,差异有统计学意义（χ2分别=6.67、7.93,P均＜0.05）,两组均无死亡病例及切口感染病例。结论因经大隐静脉置入IVCF、安全可行,并发症发生率较低,是一种新型、可供选择的手术方式之一。     

Intravascular ultrasound-guided vena cava filter placement.

PURPOSE: To report a technique for the insertion of an inferior vena cava (IVC) filter under intravascular ultrasound (IVUS) guidance. TECHNIQUE: Using a Seldinger technique, a single groin puncture provides the access for IVUS interrogation of the IVC. After the anatomy is defined with IVUS, the same guidewire is used for percutaneous IVC filter insertion. Intraoperative fluoroscopy, used as a backup, corroborates the proposed insertion location before deployment of the device. Postoperative flat-plate abdominal radiographs are used to confirm satisfactory position. IVC filters have been successfully placed in 9 patients with no complications related to IVUS-guided insertion. CONCLUSIONS: Intraluminal IVC interrogation using IVUS is ideally suited for the proper deployment of an IVC filter. The deployment of IVC filters under IVUS has the potential to further simplify an established therapy for deep venous thrombosis and pulmonary embolism.     

Cost–benefit assessment of inferior vena cava filter placement in advanced cancer patients

We retrospectively collected data recorded between 1994 and 2000, with the aim of evaluating the cost and benefits of IVCFP (inferior vena cava filter placement) in advanced cancer patients treated in our institution alone from the radio-diagnosis department's point of view. A total of 30 procedures were performed. The benefits were represented by the efficacy and the safety of the filter. The costing procedure consisted in multiplying the value of the unit index by the number of relative complexity indices. Eighty percent (24/30) of the patients were dead at the time of the study. Twenty percent (6/30) of the patients died before even being discharged from hospital. Three of them died from renal failure, owing to complete renal vein thrombosis (n=2) or hydronephrosis (n=1), and 1 from pulmonary embolism because it was exceptionally severe; the other 2 patients were cachectic, i.e., in poor general condition. The individual cost of the procedures represented only 2% of the mean entire cost of hospitalization. Seventy-six percent, 56% and 40% of the patients, were still alive at 1 month; 3 months and 6 months, respectively, with an improved quality of survival in at least 53% of the patients. The low complication rate and the low cost relative to the mean cost of hospitalization (2%) are factors in favor of using IVCFP if it is medically indicated.     

Renal artery stenosis on duplex ultrasound due to inferior vena cava filter leg impingement

We present a case study of renal artery duplex findings for new onset of hypertension in a young woman with a history of inferior vena cava filter placed a year prior and failed percutaneous retrieval. Duplex ultrasound showed significantly elevated velocities in the mid-right renal artery, consistent with renal artery stenosis. Computed tomography angiography images suggested that a leg from the inferior vena cava filter was impinging on her right renal artery, with perforation through the vena cava possibly into the wall of her duodenum. Open surgical intervention was required to disentangle the filter legs from the wall of the duodenum and relieve impingement on the right renal artery with thrombolysis of clot found within the right renal artery.     

彩色多普勒超声诊断先天性下腔静脉畸形的临床应用价值

目的分析不同类型先天性下腔静脉畸形的彩色多普勒超声表现及其相应的临床特征,探讨彩色多普勒超声诊断先天性下腔静脉畸形的临床应用价值。方法回顾性分析2009年7月至2012年3月于南京军区福州总医院超声诊断科行腹部彩色多普勒超声检查患者的临床资料,共发现22例先天性下腔静脉畸形,采用分段、多切面、自下而上或自上而下顺序进行超声扫查,结合二维、彩色多普勒、频谱多普勒超声逐段分析并进行最后的诊断,所有病例均为计算机体层扫描静脉造影、数字减影血管造影或临床其他检查所证实。结果22例下腔静脉畸形中包括左下腔静脉5例,超声表现为肾后段腹主动脉左侧上行的下腔静脉与左肾静脉汇合,肾前段跨越腹主动脉前方至右侧下腔静脉。双下腔静脉3例,超声表现为肾后段腹主动脉两侧上行的下腔静脉,肾前段左侧下腔静脉跨越腹主动脉前方经右侧下腔静脉回流入右心房：部分左下腔静脉和双下腔静脉患者伴有左肾静脉压迫。下腔静脉膜性梗阻3例,临床表现均为布-加综合征,超声显示肝后段下腔静脉右心房入口处见隔膜高回声带,彩色多普勒血流成像示肝后段下腔静脉右心房入口处未见血流,静脉腔内见逆心性血流流入腰静脉、腰升静脉。左肾静脉畸形11例,其中腹主动脉后左肾静脉9例,环主动脉型左肾静脉1例,后左肾静脉汇入左髂总静脉1例,9例伴有左肾静脉压迫。结论彩色多普勒超声可清晰显示下腔静脉及其属支的畸形,评价血流动力学的变化及其相应的临床表现,可成为下腔静脉畸形的重要诊断方法。