经皮胭静脉穿刺诊治下肢深静脉血栓39例临床分析

目的探讨经皮胭静脉血流顺向性介入治疗下肢深静脉血栓的可行性。方法对39例下肢深静脉血栓患者经健侧股静脉置入下腔静脉滤器后，穿刺患侧胭静脉，以胭静脉为人路，行血管内溶栓、血栓消融器消融和（或）球囊成形及腔内支架置人术等治疗。结果经皮胭静脉穿刺均获成功，无严重并发症发生。结论以患侧胭静脉为人路，血流顺行性介入治疗下肢深静脉血栓操作简便，是一种安全有效的方法。     

经皮血管腔内成形和支架置入术在急性下肢深静脉血栓形成中的临床应用

目的 评价经皮血管腔内成形和支架置入术在急性下肢深静脉血栓形成(DVT)中的疗效.方法 根据是否接受经皮血管腔内成形和支架置入术将39例急性下肢深静脉血栓形成患者分为支架组(21例)和非支架组(18例)两组.全部患者均置入下腔静脉滤器并经患侧腘静脉行接触性抗凝溶栓治疗,17例接受血栓消融(支架组10例).结果 全部患者术后临床症状均有改善,支架组患者5日内患肢与健肢膝上、膝下15 cm处平均周径差改善更明显,治愈率和显效率明显好于非支架组(P《0.05).结论 在急性下肢深静脉血栓形成介入治疗中支架辅助的血管腔内成形术能起到更好的临床效果.     

经皮穿刺置管溶栓治疗急性髂股静脉血栓形成

目的探讨经大隐静脉穿刺入路置管溶栓治疗急性髂股静脉血栓的应用价值。方法回顾性分析我院收治经下肢顺行静脉造影证实下肢深静脉血栓形成病例297例,其中经患肢大隐静脉入路置管溶栓95例;经足背浅静脉输液顺行溶栓102例;经患肢腘静脉入路置管溶栓(100例)。对三组患者总体治疗效果及并发症发生率进行观察比较。结果大隐静脉置管组显效41例(42.86%),有效50例(52.38%),无效4例(4.76%),总有效率95.24%。足背静脉组显效13例(12.74%),有效49例(48.03%),无效40例(39.21%),总有效率66.67%。腘静脉置管组显效44例(44%),有效52例(52%),无效4例(4%),总有效率96%。结论经大隐静脉穿刺置管溶栓治疗急性髂股静脉血栓形成是有效的方法,主要优点是方法简便、安全、并发症少。     

经腘静脉穿刺插管行下肢深静脉顺行性造影10例报告

经腘静脉穿刺插管行下肢深静脉顺行性造影１０例报告潍坊市人民医院（２６１０４１）孔铭新张国华姜涛１９９６年２月至１９９７年４月，我们对１０例下肢静脉功能不全患者行经静脉插管、下肢深静脉顺行性造影，取得良好效果。现报告如下。资料与方法：本组患均为男性，...     

观察下肢深静脉血栓介入治疗的临床效果

目的探讨下肢深静脉血栓介入治疗的临床效果。方法采用回顾性方法,选取2013年8月-2015年8月以来我院收治的20例下肢深静脉血栓患者的临床资料,所有患者均采用药物对患者实施介入治疗,观察患者静脉穿刺成功率和血溶情况。结果 20例患者均一次导入溶栓导管成功,成功率为100.00%;12例患者血栓完全溶解,6例患者血栓基本溶解,2例患者血栓部分溶解;溶栓后患者后患、健侧大腿和小腿周径差明显小于溶栓前,静脉通畅度明显高于治疗前,P0.05,差异具有统计学意义。结论利用药物介入方式对患者实施下肢深静脉血栓介入治疗操作简单,成功率高,安全性强,应用效果良好。     

腘静脉置管溶栓联合髂静脉球囊扩张支架植入术治疗合并Cockett综合征的DVT

目的观察腘静脉置管溶栓联合髂静脉球囊扩张支架置入术治疗合并Cockett综合征的下肢深静脉血栓形成的疗效。方法 41例合并Cockett综合征的下肢深静脉血栓形成患者,在下腔静脉滤器保护下行腘静脉置管溶栓联合髂静脉球囊扩张,22例行髂静脉支架植入术。结果本组均无手术后死亡者,无肺动脉栓塞发生。术后3～5 d患者肢体肿胀开始消退,术后5～10 d肿胀明显消退。静脉造影示下肢静脉血栓溶解,少数残存短段血管壁毛糙。38例获随访23例下肢深静脉主干通畅、瓣膜形态良好;11例深静脉不完全通畅、瓣膜形态模糊,未发现支架移位和变形;4例髂静脉支架内血栓形成。结论腘静脉置管溶栓联合髂静脉球囊扩张支架植入术治疗合并Cockett综合征的下肢深静脉血栓疗效满意。     

恶性肿瘤并发下肢深静脉血栓形成的原因及护理进展

恶性肿瘤因其在我国的高死亡率而一直备受关注,而静脉血栓栓塞也由于其高致残率、高致死率而逐渐受到临床重视。在恶性肿瘤的患者中,同时罹患下肢深静脉血栓的病例,据报道其发生率可以达到1～11%[1],下肢深静脉血栓(limb deep venous thrombosis,LDVT)是指下肢筋膜内静脉血栓形成,包括小腿深静脉(胫前静脉、胫后静脉、腓静脉及肌肉静脉窦),以及腘静脉、股深静脉、股浅静脉、股总静脉、髂静脉[2]。临床上,患者可出现患肢肿胀疼痛等一系列症状和体     

胫前静脉入路导管接触性溶栓治疗急性下肢深静脉血栓形成的临床疗效观察

［摘要］　目的　观察胫前静脉入路导管接触性溶栓（CDT）治疗急性下肢深静脉血栓形成（DVT）的临床疗效。方法　选择阜阳市第二人民医院2019年1月至2020年3月拟行胫前静脉入路CDT治疗急性下肢DVT患者43例（发病在1周以内）。比较患者治疗前后健患侧下肢周径差。观察患者治疗后并发症发生情况及临床疗效。结果　经胫前静脉入路置管成功39例（90.70%）。患者术后穿刺部位无出血并发症发生，轻度疼痛5例，麻木不适3例。32例术后随访时间3～12个月，随访期间症状消失，无血栓复发及肺栓塞发生。治疗后，患者健患侧下肢周径差显著减小（P<0.05）；静脉通畅评分为(3.29±0.91)分，较治疗前的(8.47±1.09)分下降，差异有统计学意义（t=19.475，P=0.000）；平均静脉通畅率为（57.24±11.57）%；瓣膜保存率达84.38%（27/32）。结论　胫前静脉入路CDT治疗急性下肢DVT临床疗效好，手术并发症少，值得临床推广应用。     

经肱动脉入路治疗高位下肢动脉硬化闭塞症

目的探讨应用经皮经肱动脉穿刺入路介入治疗高位下肢动脉硬化闭塞症的安全性和有效性。方法回顾2008年3月～2010年6月经皮经肱动脉穿刺入路治疗26例下肢髂动脉或股浅动脉起始段狭窄或闭塞病例,观察并发症和疗效。结果 26例肱动脉穿刺的一针技术成功率为80.77%,38条患肢闭塞的髂动脉或股浅动脉起始段术中开通率为100%。术后穿刺部位皮下血肿1例（3.85%）,穿刺部位较明显的疼痛17例（65.38%）,无神经相关并发症;术后1周、1个月、3个月未发现肱动脉狭窄或闭塞;术后6个月行动脉CTA发现2例患肢出现左下肢股浅动脉起始段再狭窄（〉50%）,血管通畅率为94.74%。结论经肱动脉入路治疗高位下肢动脉硬化闭塞症有较高的安全性和有效性,可作为股动脉入路的替代治疗途径。     

介入治疗深静脉血栓中放置下腔静脉过滤器远期疗效的分析

目的　评价放置下腔静脉过滤器在介入治疗深静脉血栓中的作用和远期疗效。方法　对 4 2例患下肢深静脉血栓病人的 5 2个患肢在进行介入治疗前先放置下肢静脉过滤器 ,再行深静脉血栓的介入治疗 ,包括机械溶栓 ,导管接触溶栓 ,球囊扩张及支架放置等。并对治疗后病人追踪随访 ,随访期 2～ 6 6个月 ,平均 19个月 ,了解过滤器放置后的状态 ,术后并发症及有无再发肺动脉栓塞。结果　 1枚过滤器 6个月后复查倾斜角 >2 0°,其余 4l枚滤器均开放良好 ,全部病人随访期内未出现肺栓塞 ,深静脉血栓症状明显改善。结论　在深静脉血栓介入治疗中放置下腔静脉过滤器 ,可预防肺栓塞的发生 ,其远期疗效肯定     

Real-time ultrasound in the diagnosis of acute deep venous thrombosis of the lower extremity

One hundred twenty-six patients with clinically suspected acute deep venous thrombosis of the lower extremity (DVT) were examined comparatively with ultrasound and venography. In total, 174 lower extremity venograms were obtained. Ultrasonic examinations were performed on patients in the supine position. The venous segments were evaluated almost exclusively with transversal scanning. In the thigh, the only criterion for DVT was the reduced or absent compressibility of the venous lumen when gently compressed with the transducer. In the calf, normal unobstructed veins can usually not be viewed in the supine patient, whereas thrombotic veins appear as sonolucent, incompressible channels. Eight-three of the 174 lower extremity venograms were positive for DVT. In the majority of cases (53 of 83) the thrombotic process had involved two or more segments in combination. The sites of involvement of the different venous segments were distributed as follows: 24 occlusions of the common femoral vein, 52 of the superficial femoral vein, 56 of the popliteal vein, and 71 of the calf veins. Ultrasound had a sensitivity of 100% for thrombosis of the common femoral vein, 96% for the superficial femoral veins, 98% for the popliteal vein, and 93% for the calf veins. For the entire lower extremity, in regard to the diagnosis of thrombosis, the overall sensitivity was 95%. In 90% the extension of the occlusion was foreseen correctly. In no cases were false-positive results reported. Thus the overall specificity was 100%. The authors conclude that real-time ultrasound is a highly accurate method for the diagnosis of DVT of the lower extremity. It is the only indirect method capable of evaluating the venous system of the thigh, as well as that of the calf, with high accuracy. It should be the first choice of diagnostic imaging method in the diagnosis of deep venous thrombosis of the lower extremity.     

Acute right lower extremity iliofemoral deep venous thrombosis secondary to an anomalous inferior vena cava: a report of two cases

A congenital anomaly of the inferior vena cava is an increasingly identified risk factor for iliocaval deep venous thrombosis in young patients. We present two cases of acute right lower extremity iliofemoral deep venous thrombosis in 16 and 18-year-old patients that were ultimately diagnosed with an underlying anomalous iliocaval venous system. In one patient, the inferior vena cava was congenitally absent and the right iliac vein was diffusely stenotic with a proximally located high-grade stricture. In the other subject, the infrarenal inferior vena cava and right iliac vein were diffusely hypoplastic. Compensatory venous flow in both subjects was via large perilumbar venous collateral veins and a prominent azygous system. Both patients were successfully treated with a combination of initial catheter-directed thrombolysis followed by balloon angioplasty and venous stent placement.     

下肢深静脉血栓形成62例综合治疗分析

目的探讨综合治疗下肢深静脉血栓形成的临床效果。方法对62例下肢深静脉血栓形成患者采取下腔静脉滤器置人、手术取栓、溶栓、抗凝、祛聚、穿减压袜等综合治疗。结果治愈43例(69.35%),好转15例(24.19%),无效4例(6.45%),无死亡病例。总有效率为93.5%。结论综合治疗下肢深静脉血栓形成效果好,可缩短病程,值得推广应用。     

Risk factors, management and primary prevention of thrombotic complications related to the use of central venous catheters

An adequate vascular access is of importance for the treatment of patients with cancer and complex illnesses in the intensive, perioperative or palliative care setting. Deep vein thrombosis and thrombotic occlusion are the most common complications attributed to central venous catheters in short-term and, especially, in long-term use. In this review we will focus on the risk factors, management and prevention strategies of catheter-related thrombosis and occlusion. Due to the lack of randomised controlled trials, there is still controversy about the optimal treatment of catheter-related thrombotic complications, and therapy has been widely adopted using the evidence concerning lower extremity deep vein thrombosis. Given the increasing use of central venous catheters in patients that require long-term intravenous therapy, the problem of upper extremity deep venous thrombosis can be expected to increase in the future. We provide data for establishing a more uniform strategy for preventing, diagnosing and treating catheter-related thrombotic complications.     

In-Hospital Risks and Management of Deep Venous Thrombosis According to Location of the Thrombus

BackgroundWhether deep venous thrombosis involving the pelvic veins or inferior vena cava is associated with higher in-hospital mortality or higher prevalence of in-hospital pulmonary embolism than proximal or distal lower extremity deep venous thrombosis is not known.MethodsThis was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample, 2016, 2017. Patients hospitalized with a primary diagnosis of deep venous thrombosis at known locations were identified by International Classification of Diseases-10-Clinical Modification codes.ResultsIn-hospital all-cause mortality with deep venous thrombosis involving the inferior vena cava in patients treated only with anticoagulants was 2.2% versus 0.8% with pelvic vein deep venous thrombosis (p<0.0001), 0.7% with proximal deep venous thrombosis (p<0.0001) and 0.2% with distal deep venous thrombosis (p<0.0001). Mortality with anticoagulants was similar with pelvic vein deep venous thrombosis compared with proximal lower extremity deep venous thrombosis, 0.8% versus 0.7% (p=0.39). Lower mortality was shown with pelvic vein deep venous thrombosis treated with thrombolytics than with anticoagulants, 0% versus 0.8% (p<0.0001). In-hospital pulmonary embolism occurred in 11% to 23%, irrespective of the site of deep venous thrombosis.ConclusionPatients with deep venous thrombosis involving the inferior vena cava had higher in-hospital mortality than patients with deep venous thrombosis at other locations. Pelvic vein deep venous thrombosis did not result in higher mortality or more in-hospital pulmonary embolism than proximal lower extremity deep venous thrombosis. The incidence of in-hospital pulmonary embolism was considerable with deep venous thrombosis at all sites.     

多层螺旋CT血管成像诊断下肢静脉阻塞性病变的应用价值

目的探讨多层螺旋CT血管成像（MSCTA）在下肢静脉阻塞性病变中的临床应用价值。方法分析40例经数字减影血管造影（DSA）证实为下肢静脉阻塞性病变患者的MSCTA影像资料,以DSA检查为诊断标准,评价MSCTA在下肢静脉阻塞性病变中的应用价值。结果 40例患者中MSCTA发现下肢静脉阻塞性病变39例,其中下肢静脉血栓形成32例;髂静脉受压综合征12例,其中5例合并下肢深静脉血栓形成。下肢静脉阻塞性病变的MSCTA诊断结果与DSA比较差异无统计学意义（P〉0.05）。结论 MSCTA对下肢静脉阻塞性病变的诊断具有较高的临床应用价值。     

Anomalies of the inferior vena cava in patients with iliac venous thrombosis

BACKGROUND: Cases of deep venous thrombosis in the lower extremities triggered by abnormalities of the vena cava have been reported. OBJECTIVE: To describe anomalies of the inferior vena cava in patients with deep venous thrombosis. DESIGN: Prospective, consecutive case series. SETTING: University Hospital, Graz, Austria. PATIENTS: 97 patients with deep venous thrombosis. INTERVENTION: Sonography, venography, or both to diagnose deep venous thrombosis; magnetic resonance angiography to image the inferior vena cava. MEASUREMENTS: Anomalies of the inferior vena cava imaged by magnetic resonance angiography. RESULTS: 31 of 97 patients showed thrombotic occlusion of iliac veins (common and external iliac vein [ n = 29] or external iliac vein [ n = 2]). Five of 31 patients (3 men, 2 women) had an anomaly of the inferior vena cava. Anomalies were missing inferior vena cava, hypoplastic hepatic segment, and missing renal or postrenal segments. Patients with anomalies were significantly younger than the 92 patients without (mean age+/-SD, 25+/-6 years vs. 53+/-19 years; P = 0.002). In 2 patients with anomalies, the thrombotic occlusion was recurrent. CONCLUSIONS: An anomaly of the inferior vena cava should be suspected if thrombosis involving the iliac veins is seen in patients 30 years of age or younger. Patients with both an anomaly and thrombosis may be at higher risk for thrombotic recurrence.     

下肢静脉造影对老年人下肢静脉疾病的诊断价值

目的探讨下肢静脉造影对老年人下肢静脉疾病的诊断价值及老年人下肢静脉疾病的特点。方法对36例疑有下肢静脉疾病、年龄≥60岁的老年人进行常规或数字减影下肢静脉造影。根据造影表现进行分析。结果36例老年病例共55侧肢体下肢静脉造影均获成功,其中54侧为阳性。根据X线表现分类:静脉阻塞性病变30侧(54.5%),静脉逆流性病变23侧(41.8%),静脉瘤样病变1侧(1.8%)。深静脉血栓形成及形成后再通为主要表现。结论下肢静脉造影对老年人下肢静脉疾病的诊断及分类具有重要价值。本组病例中老年人下肢静脉疾病以下肢静脉阻塞性疾病居多。     

Compression ultrasonography in hospitalized patients with suspected deep venous thrombosis

Compression ultrasonography was compared with contrast venography in 215 hospitalized patients (218 limbs) with suspected deep venous thrombosis. All scans were performed using a 5-MHz linear-array scanner. The calf veins were not assessed owing to their small caliber. Distribution of deep venous thrombosis was proximal in 113 of 215 patients (number of limbs with deep venous thrombosis being the same as the number of patients) and limited to the calf veins (distal) in 29 patients. Deep venous thrombosis was detected by compression ultrasonography in 101 of 113 patients (sensitivity, 89%) and falsely diagnosed in two of 76 limbs (73 patients) with negative venographic results (specificity, 97%). The method was less sensitive below the knee, where deep venous thrombosis of the distal popliteal vein was not detected in five of 10 patients as compared with seven of 103 patients with thrombus extension above the knee. Pelvic vein deep venous thrombosis (n = 34) was detected by compression ultrasonography in 71% of the patients. The results of this study indicate that venography may be omitted in patients where compression ultrasonography demonstrates proximal deep venous thrombosis. In patients with negative compression ultrasonographic results, however, venographic verification is needed since venography has a considerably higher sensitivity than compression ultrasonography in detecting isolated iliac and calf vein deep venous thrombosis.