双股静脉入路治疗髂-股静脉血栓的临床研究

目的　探讨应用双股静脉入路技术 ,治疗髂 -股静脉血栓 (I -FVT)的有效性。方法　下肢深静脉顺行造影证实为I -FVT患者 18例。经健侧股静脉置入下腔静脉滤器 ,然后经健侧股静脉置管于患侧髂静脉入下腔静脉处造影。导丝导管无法进入患侧髂 -股静脉者 ,行患侧股静脉穿刺插管 ,顺行开通股 -髂静脉至下腔静脉内。随后再经健侧插管至患侧开通段内 ,并继续开通下方的闭塞段。对开通段用球囊导管顺次扩张、拖拉 ;对闭塞段中较松软的血栓应用血栓消融器 (ATD)或溶栓导管 (OASIS)进行消融或抽吸术 ;术后保留导管 1～ 6d ,持续行接触性溶栓与抗凝治疗 ,撤管后继续行严格抗凝、溶栓治疗。结果　 18例经双股静脉入路治疗者 ,15例取得明显的疗效 ,表现为患肢肿胀迅速消退 ,疼痛消失 ,肢体松软 ,活动恢复正常 ;另外 2例开通后 ,患肢肿胀减轻 ,好转出院 ;1例未能开通 ,经同侧足背静脉静滴抗凝、溶栓药物 ,症状好转出院。全部病例均未发生肺梗死。术后随访 3～ 39个月 ,平均 16.4个月 ,无症状性复发。结论　双股静脉入路治疗I -FVT ,是一种较为简便、安全、有效的方法     

下腔静脉滤器在下肢深静脉血栓治疗中的意义

目的评价置入下腔静脉滤器预防下肢深静脉血栓脱落引起肺栓塞的价值及实行导管溶栓的方法.方法34例下肢深静脉血栓患者分别经右侧股静脉(26例)或右颈静脉(8例)置入波士顿公司的Greenfield滤器或巴德公司Simon's滤器.下腔静脉滤器置人后,将溶栓导管经右股静脉插人到左髂总静脉,经右颈内静脉插入到左髂总静脉进行溶栓.药物尿激酶100～150万u.结果下腔静脉滤器置入全部成功.溶栓经右侧股静脉26例,成功12例,成功率为47%;经颈静脉8例均成功.结论置人下腔静脉滤器防肺栓塞是操作简单、安全有效的方法.经颈静脉溶栓,成功率高,效果好,值得推广.     

下肢深静脉血栓综合性介入治疗

目的 回顾性分析下肢深静脉血栓(DVT)综合性介入治疗的方法及疗效,并就相关临床资料和并发症进行总结.方法 收集2000年8月-2010年8月DVT患者196例,先经健侧股静脉穿刺置管行髂股静脉造影明确血栓部位与程度.196例中,放置下腔静脉滤器185例,髂静脉支架21例,采用经导管溶栓、扩张球囊破栓.若球囊对狭窄部扩...     

介入治疗急性左髂股静脉血栓——先溶栓或先扩张

目的 评价两种不同介入治疗程序(先溶栓或先扩张)在治疗急性左髂股静脉血栓中的近期疗效和并发症发生率的差异.方法 将45例急性左下肢中央型深静脉血栓患者分为两组.A组21例,经左侧胭静脉插入溶栓导管到髂股静脉血栓内,行导管溶栓,治疗后如有残留狭窄,再行球囊扩张或支架置人.B组24例,经左侧胭静脉置鞘,对左侧髂静脉和血栓先...     

经大隐静脉穿刺置管溶栓治疗急性期髂股静脉血栓形成

目的:探讨经大隐静脉入路置管溶栓治疗髂股静脉血栓形成的应用价值。方法:对18例急性期髂股静脉血栓形成的患者在下腔静脉滤器植入术前提下,经大隐静脉入路置管溶栓治疗。结果:18例患者经大隐静脉穿刺成功置管,技术成功率为100%,治疗有效率为100%。置管期间无不良反应及并发症发生;平均住院时间为12.5d。结论:经大隐静脉入路置管溶栓介入治疗急性期髂股静脉血栓操作简便,经济实用,安全有效。     

左髂静脉受压综合征并发下肢深静脉血栓形成的综合介入治疗

目的 探讨介入治疗髂髂静脉受压综合征并发左下肢深静脉血栓形成的临床价值.方法 对28例左髂静脉受压综合征并发左下肢深静脉血栓形成患者采用经颈静脉插管溶栓、左髂静脉球囊扩张及支架治疗,部分血栓已蔓延至下腔静脉的患者在溶栓前行下腔静脉滤器置入.结果 28例患者均在术前彩色多普勒超声检查及术中造影检查明确诊断;5例行可回收性下腔静脉滤器置入,所有患者均经颈静脉置入溶栓导管于髂股静脉进行溶栓治疗,髂股静脉血栓溶解率100%,溶栓后均予以球囊扩张左髂总静脉,其中6例置入髂静脉支架.术后肢体肿胀症状明显减轻或消失,随访3～12个月临床效果满意.结论 采用滤器置入、经颈静脉溶栓、髂静脉球囊扩张及支架治疗左髂静脉受压综合征并发左下肢深静脉血栓形成是一种安全、微创、有效的治疗手段,具有较好的效果,值得临床推广.     

滤器源性腔-髂静脉血栓形成的介入治疗:AngioJet血栓清除术与大腔导管抽吸术的疗效比较

目的 探讨AngioJet流变式血栓清除术与大腔导管抽吸术在治疗滤器源性腔-髂静脉血栓中的疗效及安全性.方法 搜集2018年3月至2020年3月23例急性滤器源性下腔静脉-髂静脉血栓患者,行导管接触性溶栓治疗后均效果不佳,并行经皮机械性血栓清除术.其中大腔导管抽吸组12例,AngioJet机械性血栓清除组11例.对两组...     

经小隐静脉入路介入治疗髂-股静脉血栓的探讨

目的 探讨经小隐静脉入路血管腔内介入方法治疗髂-股静脉血栓(I-FVT) 的疗效.方法 对28例I-FVT患者从健侧股静脉逆行插管失败,改行患侧小隐静脉切开置管溶栓并辅以导丝碎栓、导管抽吸、球囊导管顺次扩张;髂静脉流出道狭窄者行球囊扩张支架植入术.结果 28例急性及亚急性I-FVT患者经患侧小隐静脉置管溶栓治疗的患者,全部成功置管,溶栓导管侧孔段位于髂静脉至腘静脉间;7例取得明显的疗效,表现为患肢肿胀迅速消退,疼痛消失,肢体松软,活动恢复正常;17例患肢肿胀减轻,患肢活动度接近正常,造影血流大部分恢复,好转出院;4 例症状改善不明显.全部病例均未发生肺梗死.术后随访25例,随访时间6 ~ 24个月,平均14.6 个月,静脉通畅无陈旧血栓18例,有陈旧血栓、静脉腔 > 70%者5例,复发2例,静脉血栓后遗症3例.随访病例中,无下腔静脉阻塞、肺动脉栓塞等并发症.结论 经小隐静脉入路留置溶栓导管辅助介入血栓清除的技术治疗I-FVT,手术成功率高、安全、有效、创伤小,临床可予应用.     

血栓消融器(ATD)在下肢深静脉血栓形成治疗中的应用

目的　评价血栓消融器 (ATD)在下肢深静脉血栓形成 (LEDVT)的介入治疗中的应用价值。方法　LEDVT患者 17例 ,病变在左侧髂股静脉 8例 ,右侧髂股静脉 7例 ,双侧髂股静脉 2例。经健侧股静脉 (或右颈内静脉 )穿刺先置入下腔静脉滤器 ,然后经患侧股静脉或静脉穿刺插管 ,行血栓消融术 ,并结合血管内溶栓治疗。结果　本组 17例患者 ,技术成功率为 10 0 % ( 17/17)。临床疗效 :痊愈 3例、显效 11例、有效 3例 ,总有效率为 10 0 % ( 17/17)。无严重并发症发生。术后表现为髂 -股静脉通畅 ,肿胀消退。随访无复发。结论　采用ATD行血栓消融术并配合综合溶栓治疗下肢深静脉血栓是简单实用、安全有效的介入治疗方法     

AngioJet血栓清除装置一次性治疗急性下肢深静脉血栓形成的应用

目的初步研究采用AngioJet血栓清除装置及其辅助措施一次性治疗急性下肢深静脉血栓形成的可行性、安全性和有效性。方法回顾性分析2016年06月~2016年12月连续收治的急性下肢深静脉血栓形成患者18例。采用治疗方案:放置Aegisy可回收滤器,滤器释放后不予解脱,球囊导管对血栓段行扩张碎栓,AngioJet导管行血栓抽吸,若合并髂静脉狭窄则同期行球囊扩张,残余狭窄50%时同期植入支架,血栓清除后即刻取出滤器,术后保留鞘管溶栓,24h造影复查。结果治疗过程中3例未置滤器,15例置入临时滤器,其中12例(12/15,80.0%)滤器同期取出,3例(3/15,20.0%)溶栓结束后取出。15例患者合并髂静脉狭窄,同期扩张后植入髂静脉支架16枚。所有患者均未放置溶栓导管。术后即刻血栓清除Ⅲ级13例(13/18,72%),Ⅱ级5例(5/18,28%),经鞘管溶栓后血栓清除Ⅲ级15例(15/18,83%),Ⅱ级3例(3/18,17%)。血栓平均抽吸时间(216.61±56.60)s,平均尿激酶用量(108.89±56.45)万U,平均溶栓时间(36.00±18.86)h。无症状性肺栓塞、严重出血以及其他严重并发症发生。随访时间6~11月,持续静脉通畅,无血栓复发。结论利用AngioJet血栓清除装置及其辅助措施一次性治疗急性下肢深静脉血栓形成是一种安全、有效的方法,简化了介入治疗过程,提高患者舒适度,具有潜在的缩短溶栓时间及减少用栓药物剂量、提高血栓清除效率等优势。     

Exercise Causing Thrombosis

Abstract

Thrombophilia refers to the increased tendency to form blood clots (thrombosis), which is a major cause of morbidity and mortality. Thrombosis is associated with various chronic conditions such as cancer, diabetes, renal disorders, and cardiovascular disease. The incidence and associated complications of thrombosis are likely to increase significantly in the next few decades because of aging populations. Regular exercise has been proposed to decrease the risk of developing thrombosis, although there are inconsistent data from studies investigating its effects, with reports of both increased and decreased thrombotic risk across a variety of subject cohorts. Confounders such as age, gender, hormonal variations, physical activity, underlying disease and treatment, and body composition also contribute to the difficulty in assessing and defining the precise effects of exercise in preventing thrombotic events. However, there is evidence suggesting that physical activity is beneficial for reducing thrombotic risk in younger individuals and those with chronic conditions. This article aims to summarize the known risk factors for thrombosis and briefly review the benefits of exercise in the general population. Furthermore, this article highlights the additional factors in a cohort of individuals that would (at first) appear unlikely to be at risk of thrombosis—elite athletes.     

Thrombosis at mountain altitudes

Victims of high-altitude pulmonary edema often have clots obstructing the pulmonary vessels. This, together with an apparent high incidence of thrombophlebitis and cerebral emboli at altitude suggests that mountain travel may predispose to hypercoagulability. A critical analysis of the available data suggests that, although thrombosis may be a late event complicating various forms of mountain sickness, the laboratory techniques of characterizing hypercoagulability are not sufficient to define and characterize the mechanism.     

Thrombosis of the popliteal vein

Among 3,307 consecutive patients (3,556 legs) with deep venous thrombosis, 54 (1.5%) showed an isolated thrombus of the popliteal vein on phlebography. The majority of those had a history of “effort” or long lasting flexion during air or bus travel. Forty-four percent suffered from pulmonary embolism as the first sign of deep venous thrombosis. Functional phlebography demonstrated the primary site of thrombosis at folds forming in the vein wall at flexion. In order to further elucidate the pathogenetic mechanism, 158 popliteal veins were examined phlebographically in different functional states revealing age-related characteristic wall patterns of rings and folds in flexion causing transient impairment of flow. Complementary morphological studies of 120 popliteal veins during autopsy showed a transverse rippling of the vein wall caused by intimal fibrosis and partial atrophy of the media corresponding to the phlebographic findings. It is concluded that microtrauma during effort in combination with impaired venous backflow and fibrotic transformation of the venous wall can lead to thrombus formation in the popliteal vein.     

Thrombosis detection using radionuclide techniques.

Radionuclides have been used in the evaluation of intravascular thrombosis for several years. The most widely accepted nonimaging technique is I-125 labeled fibrinogen. It is commonly used for patients who have a high probability of developing a thrombus (e.g., those undergoing surgery). Other techniques are emerging as having value in thrombosis detection. These techniques include radionuclide venography and clot localization scanning techniques utilizing the affinity of clot for small radiolabeled particles, as well as imaging techniques using I-131 labeled fibrinogen. More recently, a number of the above-mentioned techniques have been applied to patient problems. The FDA ban on commercial radiolabeled fibrinogen in the United States has promoted the development of alternative techniques and the use of autologous fibrinogen. A number of other techniques for thrombosis detection have also been explored on a more experimental basis. They include the use of thrombolytic agents such as streptokinase, urokinase, and white blood cells, as well as platelets. The common lung or pulmonary perfusion scan using macroaggregates of albumin or microspheres radiolabeled also gives information as to the presence of thrombosis of embolus within the pulmonary arteries, by showing the effect upon the perfusion pattern. This review will explore in detail the principles, as well as the present and prospective usefulness of the techniques currently available.     

Stent Placement on Fresh Venous Thrombosis

Purpose: To report on the efficacy of fixing fresh venous thrombus to the venous wall by stent placement. Methods: Seven patients underwent stenting to treat acute venous thrombosis. In two patients, the hemodialysis fistula was thrombosed with the thrombus extending into the brachial veins. In three patients, the hemodialysis fistula was patent but massive swelling of the ipsilateral arm was caused by proximal venous thrombosis. Two patients presented with iliac venous thrombosis within stented pelvic veins. Stent placement was preceded by other mechanical thrombectomy methods in all cases. Results: Attachment of thrombus to the venous wall was successful in all cases treated. Acute rethrombosis did not occur. Follow-up patency in dialysis patients was 7.2 ± 2.1 months. One patient had rethrombosis of the dialysis graft 3 months after primary treatment. Three patients developed restenosis within a mean period of 7.7 months. One shunt remained patent for 10 months with no event of reobstruction during follow-up. In both patients with iliac stent placement, the vein remained patent over a follow-up period of 8 and 12 months respectively. Conclusion: Stenting fresh venous thrombus can achieve immediate venous patency. It may be used as an alternative approach when all other percutaneous methods fail. Frequent restenosis within stented veins limits its use to very selected cases. Received: 0/00/00/Accepted: 0/00/00