急性大面积肺梗死的介入机械碎栓治疗

目的探讨急性大面积肺梗死介入机械碎栓治疗的可行性和临床疗效。方法对15例急性大面积肺栓塞患者采用碎栓器械行介入治疗,观察临床症状、肺动脉平均压、血氧分压和肺动脉开通情况。结果疗效评价为11例显效,3例好转,1例无效,术后动脉血氧分压明显升高,由(60.6±7.8)mmHg升至(91.0±7.7)mmHg,P=0.00;肺动脉平均压明显降低由(39.7±10.8)mmHg降至(27.3±7.9)mmHg,P=0.000。结论介入机械碎栓治疗急性大面积肺栓塞是一种可行且行之有效、安全的方法。     

单纯经皮机械祛栓治疗急性大面积肺栓塞的临床应用

目的评价单纯介入机械祛栓在治疗急性大面积肺栓塞(PE)方面的临床疗效和安全性。方法回顾性收集2003年1月到2008年1月经皮机械碎栓(PMT)或(和)Straub Rotarex系统祛栓治疗急性大面积PE病例6例。结果6例患者的肺动脉主干血流得以再通且临床症状改善。介入术后,患者SaO2从术前79.5%±5.3%增加至92.8%±3.4%(P<0.01);PaO2从术前从(58.0±9.8)mmHg增加至(88.7±4.1)mmHg(P<0.01);术后患者的平均肺动脉压(PAP)从(40.8±7.8)mmHg降至(29.8±8.0)mmHg(P<0.01);Miller指数从术前的0.54±0.03降至术后的0.18±0.07(P<0.01)。在完成临床随访的4例患者中,1～5年内均未有PE复发。结论初步临床经验显示单纯PMT是治疗急性大面积PE的一种简单、有效、安全的方法,尤其是针对有溶栓禁忌证的患者。     

经导管祛栓术治疗急性肺动脉栓塞

目的：探讨经导管栓子祛除术治疗急性肺动脉栓塞的临床疗效。方法：对24例急性肺动脉栓塞的病人，经肺动脉造影明确诊断，通过旋转猪尾导管碎栓、抽吸导管抽吸和局部溶栓来开通肺动脉。观察临床症状、动脉血氧分压（PaO2)、肺动脉平均压（PAPm）和肺动脉开通情况。结果：术后症状即刻缓解者23例，完全开通者20例，与术前相比PaO2明显升高（P＜0．05），PAPm明显降低（P＜0．05），并发脑出血1例，死亡2例，22例病人存活。结论：经导管栓子祛除术治疗急性肺动脉栓塞是安全有效的方法。     

静脉溶栓联合导管碎栓和切栓治疗急性大面积肺栓塞

目的评价静脉溶栓联合导管碎栓和切栓治疗急性大面积肺栓塞的临床疗效和安全性。方法对19例急性大面积肺栓塞患者，采用下腔静脉滤器置入、肺动脉导管碎栓和静脉溶栓加低分子肝素抗凝治疗，19例中4例加用了Straub Rotarex导管血栓旋切术。结果19例共行21次治疗。18例经介入治疗后胸闷、紫绀症状均明显改善，肺动脉中央分支血流恢复通畅，血氧饱和度由术前平均86％（74％～96％）上升到治疗后的平均97％（94％～100％）。肺动脉压力从术前的（334-5）mmHg（1mmHg=0．133kPa）下降到术后的（254-5）mmHg（t=13．2，P〈0．01）。l例双侧肺动脉主干大块血栓栓塞的患者，介入治疗无效，后经胸外科手术取栓未能成功，患者死亡。4例成功地采用了Straub Rotarex旋切治疗肺动脉血栓，未出现并发症。结论采用导管碎栓和血栓旋切等介入技术联合静脉溶栓抗凝治疗，是治疗急性大面积肺动脉栓塞的有效而且安全的方法。     

AngioJet血栓清除术补救溶栓失败的急性大面积肺栓塞初步临床研究

目的:初步探讨AngioJet药物机械偶联式血栓清除术（APMT）补救尿激酶（UK）溶栓失败的急性大面积肺栓塞（AMPE）患者的安全性和临床疗效。方法:搜集2016年6月至2018年6月间南京医科大学附属南京医院介入血管科采用APMT后续补救UK治疗AMPE失败的患者16例的临床资料。对单独UK治疗失败患者予APMT辅...     

介入机械性血栓清除术治疗急性肺栓塞

目的探讨应用介入机械性血栓清除术治疗急性肺栓塞的方法、疗效和安全性。方法对26例急性肺栓塞患者,行肺动脉造影明确栓子部位,应用机械血栓清除器械(Amplatz血栓消融器17例,Straub血栓旋切器9例)行介入血栓清除术,观察临床症状、肺动脉血栓清除情况、血氧饱和度(SaO2)、肺动脉平均压(MPAP)、动脉血氧分压(PaO2)。25例明确伴下肢深静脉血栓形成者,介入血栓清除术后放置下腔静脉滤器。结果本组均成功行介入机械性血栓清除术,26例患者介入术后临床症状均明显改善,SaO2明显上升,MPAP明显下降,PaO2明显升高,21例肺动脉内血栓大部分清除,无严重手术相关并发症。术后随访1～36个月,患者无肺动脉栓塞复发。结论介入机械性血栓清除术治疗急性肺栓塞是创伤小、安全易行、疗效确切的治疗方法。     

创伤后急性大面积肺栓塞的切开取栓治疗

目的 探讨肺动脉切开取栓治疗创伤后急性大面积肺栓塞的方法、围术期处理及外科治疗的安全性.方法 回顾总结自2001年3月至2007年2月采用肺动脉切开取栓治疗的7例急性大面积肺栓塞资料.7例患者在病史中均有近期手术或外伤史,其中男性5例,女性2例,年龄(45±7)岁.所有患者术前均采用CT或肺动脉造影确诊,手术在中低温体外循环辅助下完成.患者出院后随访3～12 个月.结果 8例患者术后即刻肺动脉压下降20～30 mm Hg(1 mm Hg=0.133 kPa),血氧饱和度恢复至100%.体外循环转流时间(67±11) min,失血量(870±34) ml,术后呼吸机辅助时间(161±13) h.1例偏瘫患者术后5个月死于肺部真菌感染,其余6例患者均康复出院.所有患者均未放置下肢静脉滤网,采用华法林钠抗凝,维持国际凝血比值(INR) 2～3.随访复查CT与肺通气-灌注扫描可见肺血管显影良好,无肺动脉高压形成. 结论早期行肺动脉切开取栓是治疗创伤后急性大面积肺栓塞的有效方式,并且可防止慢性肺动脉高压的形成.     

机械血栓清除术治疗急性下肢深静脉血栓患者围术期护理

目的 探讨机械血栓清除术治疗下肢深静脉血栓围手术期护理措施.方法 回顾性分析2015年1月至2016年2月,在血管外科行机械血栓清除术的9例患者的临床资料,总结其护理方法,探讨护理要点.结果 患者均成功完成机械血栓清除治疗,9例患者术后均恢复静脉血流.经过术后严密的治疗护理,患者下肢肿胀症状均明显改善(P＜0.05),无围术期并发症发生.结论 机械血栓清除术治疗下肢深静脉血栓围术期护理尤为重要,掌握护理重点,做好相应的护理措施,有助于患者病情恢复.     

流变血栓清除术治疗急性下肢深静脉血栓形成

目的　评价流变血栓清除术治疗急性下肢深静脉血栓形成的临床疗效与安全性。资料与方法　 17例 1周内的急性下肢深静脉血栓形成患者 ,其中血栓形成位于髂静脉 1例 ,髂股静脉 4例 ,股静脉 6例 ,股静脉 5例 ,静脉 1例。血栓长度 4～ 3 0cm ,平均 11.2 9± 5 .86cm。采用经皮穿刺方法 ,置入 6F或 8FOasis流变溶栓导管并与高压注射器连接 ,将生理盐水以 2 .5ml/s的流率和 5 171kPa的压力注入 ,行流变血栓清除术 ,观察血管开通、临床疗效以及并发症发生情况。结果　流变血栓清除术后 ,17例重建了前向血流 ,并清除了绝大部分血栓物质 ,技术成功率 (残留狭窄 <5 0 % )为 10 0 %。 15及 3 0天的初始血管开通率均为 10 0 % ,无严重并发症发生。结论　流变血栓清除术能迅速、安全、有效地清除下肢深静脉急性血栓     

急性大面积肺动脉栓塞的介入治疗及疗效评价

目的 评价经血管栓子祛除术治疗急性大面积肺动脉栓塞的疗效和安全性.方法 对12例经CT肺血管造影或血管造影证实为大面积肺动脉栓塞患者,经肺动脉行传统介入器材碎栓、吸栓及局部溶栓联合治疗,观察临床症状、体征,血气分析及血流动力学改变,肺动脉开通情况以及有无并发症.结果 介入治疗后血管开通良好、症状即刻缓解9例,2例术后数天内症状逐步好转.PaO2术前(54.92±6.17)mmHg,术后达(90.91±1.62)mmHg,SaO2术前(85.17±8.39)%,术后达(95.75±1.96)%,差异有统计学意义(P均<0.01),休克指数明显下降(1.26±0.18/0.67±0.14,P<0.01),Miller评分明显降低(21.75±4.35/13.83±5.69,P=0.0001),mPAP显著下降[(35.59±7.68)mmHg/(30.04±7.93)mm Hg,P=0.001].1例因栓塞面积大,术后3 d死亡,术后并发脑出血1例,3 d后死亡.结论 经肺动脉行血管祛栓综合治疗急性大面积肺动脉栓塞是一种安全有效的方法 .     

Use of rheolytic thrombectomy in treatment of acute massive pulmonary embolism

PURPOSE: The 6-F Xpeedior (AngioJet; Possis Medical, Minneapolis, MN) rheolytic thrombectomy catheter (RTC) uses high velocity saline jets for thrombus aspiration, maceration, and evacuation, through the Bernoulli principle. The purpose of this study was to evaluate the efficacy of thrombus removal using the RTC in patients with acute massive pulmonary embolism (PE). MATERIALS AND METHODS: Seventeen patients (mean age, 51.7 + 16.6 years; range, 30-86 years; 9 men, 8 women) with massive PE initially diagnosed by computed tomography (CT) or VQ scan and confirmed by pulmonary angiography were treated with the RTC. All patients had acute onset of PE symptoms and all presented with hemodynamic compromise and dyspnea. Ten of 17 patients had enough residual thrombus to warrant adjuvant catheter directed thrombolytic infusion with reteplase. Six patients had contraindications to thrombolytic therapy. One patient presented with renal cell carcinoma and tumor embolus as suspected cause of PE. Angiographic and clinical outcomes during the hospital stay were evaluated. RESULTS: The RTC was successfully delivered and operated via a 0.035-inch guide wire in all attempted cases. Treatment resulted in immediate angiographic improvement and initial relief of PE symptoms (improvement in dyspnea and oxygen saturation) in 16 of 17 patients. One patient developed heart block during the procedure, and further treatment with the RTC was discontinued. Bradycardia occurred in one patient (managed with lidocaine). After thrombectomy, 10 patients received adjunctive reteplase thrombolysis for treatment of residual thrombus, and 12 received inferior vena cava (IVC) filters. In the patient with renal cell carcinoma, histopathologic analysis of the evacuated material confirmed tumor origin of the embolism. There were two deaths, both within 24 hours of treatment and secondary to PE. One death occurred in a patient who had only minimal thrombus removal after treatment with the RTC and no thrombolysis. The remaining 15 patients showed continued improvement in PE symptoms and were eventually discharged from the hospital with mean length of stay 10.3 + 6.5 days (range, 5-30 days). CONCLUSIONS: Rheolytic thrombectomy can be performed effectively in patients with massive PE. However, a large portion of the patients in this study underwent adjuvant overnight thrombolytic infusion. Further evaluation in a larger cohort of patients is warranted to assess whether this treatment may offer an alternative or complement to thrombolysis or surgical thrombectomy.     

Manual aspiration thrombectomy with a standard PTCA guiding catheter for treatment of acute massive pulmonary thromboembolism

PURPOSE: To evaluate the efficacy and safety of percutaneous manual aspiration thrombectomy for the treatment of acute massive pulmonary thromboembolism with hemodynamic impairment. MATERIALS AND METHODS: Over a period of 6 years and 9 months, 15 patients with hemodynamic impairment (4 men, 11 women; aged 27-79 years) were treated by manual clot aspiration with a standard, large-lumen percutaneous transluminal coronary angioplasty (PTCA) guiding catheter. RESULTS: After treatment, angiography demonstrated improvement of pulmonary perfusion in all patients (mean Miller score: before treatment 18.9, after treatment 12.1; P < 0.01). Mean pulmonary arterial pressure decreased from 29.6 to 22.5 mmHg (P < 0.01). The mean treatment time was 114.2 min. All of the patients survived and their clinical status improved. No patient had any significant complication. CONCLUSION: Percutaneous manual aspiration thrombectomy with a standard 8 Fr PTCA guiding catheter achieved rapid, safe improvement of the hemodynamic situation in cases of acute massive pulmonary thromboembolism, with low cost both in terms of time and money.     

Mechanical thrombectomy of massive pulmonary embolism using an Arrow-Trerotola percutaneous thrombolytic device

Mechanical thrombectomy of a large central thrombus in massive pulmonary embolism is a new option for the treatment of this serious condition. The special mechanical devices designed to fragmentize a blood clot include the Arrow-Trerotola percutaneous thrombolytic device (PTD), the use of which in the pulmonary arteries has not yet been reported. The case of massive embolism into the left pulmonary artery with subsequent collapse is to demonstrate the immediately clinically successful treatment using the PTD. Our initial experience with the PTD shows that its use is a safe and quick procedure. Received 1 December 1997; Revision received 30 January 1998; Accepted 16 March 1998     

Mechanical thrombectomy of major and massive pulmonary embolism with use of the Amplatz thrombectomy device.

RATIONALE AND OBJECTIVES: To evaluate the feasibility of mechanical thrombectomy with the Amplatz thrombectomy device (ATD) in restoring patency of acutely thrombosed pulmonary arteries resulting from pulmonary embolism for the improvement of patient outcome. METHODS: Mechanical thrombectomy with the ATD (8F) was performed in nine consecutive patients with angiographically documented thrombus in the left or right pulmonary artery resulting from deep vein thrombosis (n = 4) or unknown cause (n = 5). RESULTS: The Miller index decreased from 18 to 11. In all patients, the majority of the thrombus in the pulmonary artery was cleared after a mean activation time of the ATD of 367 seconds. Thrombectomy was performed with the ATD alone (n = 4) or with additional long-term fibrinolysis therapy (n = 5) with infusion of recombinant tissue-type plasminogen activator. Pulmonary arterial pressure decreased from a mean of 57 mm Hg before mechanical thrombectomy to 55 mm Hg directly after the procedure and to 39 mm Hg after termination of the recombinant tissue-type plasminogen activator infusion. CONCLUSIONS: Mechanical thrombectomy with the ATD in patients with minor and major pulmonary embolism is technically feasible and safe. It is a potential alternative to drug-mediated thrombolysis and surgery. However, the incremental benefit of the ATD over conventional treatments could be shown only in a randomized controlled study.     

Amplatz血栓消融器在急性肺动脉栓塞中的临床应用

急性肺动脉栓塞（pulmonary embolism,PE）起病急,病情进展快,未经治疗病死率可高达20％～30％。我院自2001年6月始,采用Amplatz Thrombectomy Device（ATD）成功抢救了5例危重的大面积PE病例。现报道如下。