下腔静脉滤器置入术预防肺栓塞

目的评估下腔静脉滤器预防因下肢深静脉血栓所致的肺动脉栓塞的临床疗效。方法经右颈内静脉或健侧股静脉放置下腔静脉滤器43枚,常规行下腔静脉造影,将滤器放置于肾静脉开口以下的下腔静脉,术后常规抗凝。结果 43例患者下腔静脉滤器放置成功,对全部病例临床平均随访13个月(3～24个月),其中2例发生倾斜,不超过15°,1例75岁患者再次发生肺栓塞死亡,1例滤器放置处血栓形成,余39例无肺栓塞,未见滤器移位、断裂、倾斜及滤器放置部位血栓形成。结论下腔静脉滤器置入术可有效预防肺栓塞。     

经颈内静脉溶栓及经股静脉放置腔静脉滤器治疗下肢深静脉血栓的临床体会

目的探讨经颈内静脉溶栓及经股静脉放置腔静脉滤器治疗下肢深静脉血栓的临床应用价值。方法 2007年1月至2009年6月间,15例下肢DVT患者行经颈内静脉溶栓及经股静脉放置腔静脉滤器。结果下腔静脉滤器植入全部成功,溶栓治疗显效15例,无肺动脉栓塞症及严重出血发生,下肢症状消失。结论腔静脉滤器植入后溶栓治疗下肢DVT,疗效显著。     

下腔静脉滤器置入预防肺动脉栓塞11例临床体会

目的：寻求经皮穿刺下腔静脉滤器置入在治疗下肢静脉血栓中预防肺动脉栓塞的有效方法。方法：经股静脉或颈静脉穿刺放置下腔静脉滤器11例。术前均经彩超确诊深静脉血栓形成,术中常规下腔静脉造影,了解并确定下腔静脉和释放途径无血栓形成,将滤器放置在肾静脉开口之下的下腔静脉。结果：11例均成功释放,其中1例双下肢静脉血栓患者经颈静脉释放,其余经股静脉释放。有2例在彩超定位下放置滤器,其余在静脉造影下完成。术后随访1～30月,所有随访患者均未发生肺栓塞。结论：经皮穿刺下腔静脉滤器置入术操作简单,疗效确切,并发症少,创伤小,可以有效预防下肢深静脉血栓形成病人发生致命肺动脉栓塞（PE）。     

永久性腔静脉滤器的临床应用

目的探讨永久性下腔静脉滤器预防肺动脉栓塞的临床应用及指征。方法经颈内静脉和股总静脉为52例下肢深静脉血栓患者置入永久性腔静脉滤器;术中行髂静脉、下腔静脉造影,51例患者滤器放置于肾静脉开口之下的下腔静脉,1例于肾静脉开口以上;应用滤器包括Tita-nium-greenfield滤器,TrapEase滤器,LGM滤器。术后常规抗凝治疗。结果本组病例均释放成功,术后3~60个月随访,无肺栓塞发生,下腔静脉血栓1例,无其他相关并发症。结论永久性下腔静脉滤器置入可以有效预防肺栓塞,但应严格掌握适应证。     

下腔静脉滤器植入术预防肺动脉栓塞临床分析

目的 探讨下腔静脉滤器植入术在治疗下肢深静脉血栓中预防肺动脉栓塞的作用。方法 2001年3月-2005年1月,经股静脉穿刺放置永久性下腔静脉滤器12例,其中男性8例,女性4例。年龄44-81岁,平均54．2岁。深静脉血栓位于右下肢4例,左下肢8例。常规行下腔静脉造影,了解并确定下腔静脉和释放途径无血栓形成,将滤器放置到肾静脉开口下的腔静脉。结果 本组病例均释放成功,12例均经股静脉释放．术后随访1-24个月,无肺栓塞发生。结论 经皮穿刺下腔静脉滤器植入术操作简便,可以有效地预防下肢深静脉血栓患者中导致致命的肺动脉栓塞的发生。     

下腔静脉滤器置入术预防DVT继发肺栓塞的临床观察

目的 探讨下腔静脉滤器置入术在治疗下肢深静脉血栓中预防肺栓塞的作用.方法 2003年1月至2006年12月,我院行下腔静脉滤器置入共36例,其中男性24例;女性12例.年龄35-78岁,平均年龄58.3岁.深静脉血栓位于右下肢8例,左下肢22例,双下肢6例.常规行下腔静脉造影,确定下腔静脉以及释放路径有无血栓形成,将滤器放置在肾静脉开口下的下腔静脉.结果 本组病例均释放成功,经股静脉途径15例,经右侧颈内静脉途径21例,术后随访1-24月,全部病例均未出现肺栓塞.结论 下腔静脉滤器置入可以预防下肢深静脉继发肺动脉栓塞的发生.     

滤器置入溶栓在下肢深静脉血栓治疗中的应用

目的评价下腔静脉滤器置入,防止肺栓塞和治疗下肢深静脉血栓的应用价值。方法经彩色Doppler超声检查证实为下肢深静脉血栓12例患者,其中6例于健侧股静脉入路下腔静脉内放置滤器,6例采用常规疗法,15～30天后复查彩超。结果6例下腔静脉滤器置入者,显效4例,有效2例;采用常规疗法者,有效4例,无效2例。结论下腔静脉滤器置入后经尿激酶溶栓治疗下肢深静脉血栓,相比常规疗法,是保证溶栓疗效,增加其安全性和预防肺动脉栓塞的更佳治疗措施。     

下腔静脉滤器置入术的护理体会

深静脉血栓形成多发生于下肢 ,栓子脱落后可发生急性肺动脉栓塞 ,出现肺动脉栓塞后 ,死亡率较高 ,大多数病人可在 1小时内死亡。下腔静脉滤器的使用为下肢深静脉血栓患者溶栓治疗中提供了一个预防异位栓塞的作用 ,能有效地防止肺动脉栓塞的发生。我院对 5例下肢深静脉血栓的患者放置了下腔静脉滤器均获得满意效果。现将下腔静脉滤器置入术的护理体会介绍如下。1　临床资料患者男 3例 ,女 2例 ,年龄为 4 3～ 6 9岁 ,平均 5 5 .6岁。均经血管造影证实为下肢深静脉血栓。放置方法 :经健侧股静脉行下腔静脉造影并确定双肾静脉位置并做好标记 ,分…     

Trap Ease腔静脉滤器预防肺栓塞的应用研究

目的评价TrapEase腔静脉滤器对肺动脉栓塞的预防效果及使用中的并发症。方法对48例有发生肺栓塞倾向的病人行TrapEase腔静脉滤器置入术。经股静脉或锁骨下静脉或颈静脉途径穿刺插管,具体情况根据血栓位置而定。术后随访3～38个月,平均17个月。检查方法包括腹部X线平片、CT、超声,了解有无发生滤器移位及肺栓塞等并发症。结果48例滤器均置入到预定位置,技术成功率为100％。其中33例放置在肾静脉以下腔静脉段,13例放置在肾静脉以上腔静脉段,2例放置在上腔静脉。术后影像学观察未见滤器移位、断裂及腔静脉损伤。结论对有肺栓塞倾向的上下肢深静脉血栓病人,TrapEase腔静脉滤器是预防肺栓塞发生的有效工具,而且安全可靠。     

下腔静脉滤器置入术预防肺动脉栓塞96例临床分析

目的：探讨经皮穿刺下腔静脉滤器置入术在治疗下肢深静脉血栓中预防肺动脉栓塞的作用。方法：2003年3月-2006年6月。经股静脉或颈静脉穿刺放置永久性下腔静脉滤器96例。男54例。女42例；年龄34-90岁，平均66．7岁。深静脉血栓位于右下肢42例，左下肢51例，双下肢3例。常规行下腔静脉造影．了解并确定下腔静脉和释放途径无血栓形成，将滤器置于肾静脉开口下的腔静脉。结果：本组96例均释放成功，其中3例双下肢深静脉血栓的患者经颈静脉释放，其余均经股静脉释放；2例在超声定位下释放，其余均存静脉造影下完成。术后随访1-39个月。均无肺栓塞发生。结论：经皮穿刺下腔静脉滤器置入术操作简便．可以有效预防下肢深静脉血栓致肺动脉栓塞的发生。     

下腔静脉滤器植入预防肺动脉栓塞的临床应用

目的:探讨下腔静脉滤器植入预防下肢深静脉血栓形成中肺动脉栓塞的临床价值.方法:10例下肢深静脉血栓的患者进行下腔静脉滤器植入,并对疗效进行观察.结果:所有下腔静脉滤器植入和手术取栓都获得了成功,效果明显.无滤器发生移位,无肺动脉栓塞.结论:下腔静脉滤器植入是预防下肢深静脉血栓肺动脉栓塞可靠的方法.     

下腔静脉滤器植入术的临床应用

目的：评价下肢深静脉血栓形成患者植入下腔静脉滤器预防肺梗塞的效果及临床意义。方法：4例下肢深静脉血栓患者置入钛质Greenfieldfilter(TKG)3例,Bird's nest filter 1例。滤器位于双肾静脉水平以下的下腔静脉内。结果：4例滤器均成功植入,3例滤器由右股静脉穿刺植入,1例滤器经右颈静脉植入。无严重并发症发生。1例发生滤器偏斜,角度小于15度。结论：植入下腔静脉滤器预防肺梗塞是安全、有效的方法。     

彩色多普勒超声引导下经右颈内静脉置入下腔静脉滤器的临床应用

目的探讨下肢深静脉血栓形成（DVT）的患者,在彩色多普勒超声(CDFI)引导下将下腔静脉滤器（IVCF）从右颈内静脉置
入下腔静脉预防肺栓塞的可行性、安全性和临床应用价值。方法对38例经临床和CDFI检查证实为下肢深静脉血栓的患者,
经右颈内静脉置入IVCF,定期超声监测IVCF的形态与位置。临时性IVCF在放置32~45 d 后在超声引导下经右颈内静脉取
出。随访观察有无PE及滤器并发症。结果38例患者术前均经CDFI检查,右颈内静脉、下腔静脉、髂总静脉分叉、双侧肾静脉
开口位置显示均清晰,所有静脉无变异,无血栓,显示率100%。在CDFI引导下,经右颈内静脉置入临时性IVCF 23个,永久性
IVCF 15个,技术成功率100%。术后CDFI和X线腹部平片均证实滤器置入位置正确,展开完全。23个临时性IVCF 32~45 d后
均经右颈内静脉取出。随访栓子捕获率36.5%,滤器无错位、移位、断裂,患者没有出现腔静脉穿孔、肺栓塞等并发症。结论
CDFI引导经右颈内静脉置入IVCF术是一种安全、可靠的方法;相对于X线引导,CDFI引导IVCF置入术具有简便、易行、无放
射线、费用低廉等优点。
     

下肢深静脉联合腹部大血管彩超诊断深静脉血栓的价值

目的 探讨下肢深静脉联合腹部大血管的彩色超声诊断深静脉血栓(DVT)及其病因的临床价值.方法 对85例有症状的下肢DVT患者行下肢深静脉的彩超检查,其中68例血栓累及股静脉的患者同时逆行扫查髂静脉及下腔静脉.结果 85例下肢DVT患者急性期51例,亚急性期和慢性期34例,管腔内实性回声、探头加压管腔不被压瘪或消失,CDFI示血流充盈缺损或消失,PW未引出血流频谱或频谱波形不正常是DVT的特征性表现.腹部大血管扫查发现髂静脉和/或下腔静脉内的血检、瘤栓形成、左侧髂静脉受压综合征、髂静脉炎性粘连等是导致下肢DVT的病因.结论 彩色超声对下肢DVT的诊断明确,联合髂静脉、下腔静脉及周围组织的扫查可提高DVT病因的检出率,对制定临床治疗方案有指导意义.     

特发性肝下下腔静脉长段闭塞合并血栓的介入治疗

目的 评价特发性肝下下腔静脉长段闭塞合并血栓的介入治疗效果.方法 14例特发性肝下下腔静脉长段闭塞合并血栓的患者,均在局麻下经颈静脉途径联合经股静脉途径施行介入治疗,先行经导管尿激酶溶栓术,再对下腔静脉闭塞段行球囊扩张和(或)支架置入术.结果 血管造影示闭塞段位于下腔静脉肝后段至肾下段3例,位于肝下肾静脉上段11例,血栓位于下腔静脉内14例,蔓延至髂股静脉12例.治疗成功12例,下腔静脉全部开通,血栓完全溶解8例,部分溶解4例.不成功2例.8例患者平均随访(12±6)(1～36)个月,无血栓复发,下腔静脉无症状性再狭窄1例.结论 介入治疗特发性肝下下腔静脉长段闭塞合并血栓是一种安全、有效的方法.     

Clinical study of domestic ZQL-type retrievable vena cava filter

Background Pulmonary thromboembolism （PTE） is a serious disease often leading to disability and death. Percutaneous placement of an inferior vena cava （IVC） filter is an effective method to prevent fatal PTE caused by lower extremity deep venous thrombosis （LEDVT）. We developed the ZQL-type retrievable vena cava filter. The aim of this study was to evaluate the safety and effectiveness of the ZQL-type filter for prevention of fatal PTE. Methods A total of 144 patients with indications for placement of an IVC filter received insertion of filters via a femoral （n=37） or jugular （n=107） vein approach. Abdominal X-ray and color Doppler ultrasonography of IVC were regularly performed to visualize the position and condition of the IVC filter following filter placement. If thrombi in the lower extremity deep veins were removed within 2 weeks, the filter retrieval procedure was performed after an abdominal radiograph, an inferior vena cavogram and a pulmonary angiography. Otherwise, the filter should be kept permanently in place with regular follow-up inspections. Results One hundred and forty-four filters were implanted at the target sites with a success rate of 98.61% for one-time placement and 100% for two-time placement. Of the 137 patients followed up （follow-up rate, 95.14%）, 43 patients had filters retrieved during a period of between 7 and 14 days （median, 12 days） following filter placement. The remaining 94 patients were followed for 7 days to 39 months （median follow-up period, 17 months）. No filter migration or tilt, filter fracture or IVC perforation was observed. No obstruction of IVC occurred. No symptomatic PTE developed during the follow-up period. Conclusion The ZQL-type retrievable vena cava filter is a safe and effective device to prevent PTE. This filter possesses a distinctive stent-shape, stable design, high capture efficacy, and is easy to insert and retrieve and thus is suitable for clinical application. Chin Med J 2009; 122（2）： 140-144     

经颈静脉Aegisy腔静脉滤器在下肢DVT导管溶栓治疗中的临床应用

目的探讨Aegisy腔静脉滤器在下肢深静脉血栓形成（DVT）经导管溶栓治疗中的临床应用价值。方法2008年4月～2009年8月间,45例下肢DVT患者（左侧：36例,右侧：6例,双侧：3例,4例已发生肺栓塞）在经颈静脉插管溶栓过程中行Aegisy腔静脉滤器置入术,以防止肺动脉栓塞。结果45支Aegisy腔静脉滤器经颈静脉一次性于下腔静脉植入成功,技术成功率100%,术中未出现滤器错位、移位、倾斜、滤器折断、腔静脉穿孔、下腔静脉阻塞等并发症。在溶栓治疗过程中1例肺动脉栓塞患者因右心衰竭死亡,其他患者无症状性肺动脉栓塞发生。溶栓治疗后,45支滤器中的36只成功取出,滤器留置时间为7～18天（平均9.5天）,余9支滤器永久性留置于患者体内。随访2～17个月（平均9.7个月）,滤器无移位及血栓形成。结论Aegisy腔静脉滤器经颈静脉途径植入方法简单、释放可控、安全,可有效防止症状性肺动脉栓塞。     

Preliminary evaluation of magnetic resonance fresh blood imaging for diagnosis of Budd-Chiari syndrome

Background Budd-Chiari syndrome （BCS） is a rare disease with portal hypertension caused by the blockage of the hepatic vein and/or the inferior vena cava （IVC）. Angiography is the ＂golden standard＂ for diagnosis, but it is an invasive examination. To assess the diagnostic value of a fresh blood imaging （FBI） relative to BCS, we used a magnetic resonance angiography （MRA） with an FBI sequence for a preoperative evaluation of the BCS patients in this study. Methods Fifty patients who were suspected of having BCS after they had been checked by a B-ultrasound were studied. 2D and 3D FBI were performed on a 1.5T superconductive MR scanner. Original images were rebuilt using a maximal intensity projection （MIP） method on the console. Two doctors reviewed all images before they learned of the angiography results. We then compared the diagnoses obtained from the FBI and angiography results to evaluate the diagnostic value of the FBI. Results Forty-one patients were diagnosed as BCS and 9 as non-BCS based on an angiography. The FBI correctly diagnosed 38 patients, incorrectly diagnosed 1 patient, and missed diagnosis in 3 patients. Thus, the diagnostic sensitivity of the FBI is 93% （38/41）, the specificity is 89% （8/9） and the accuracy is 92% （46/50）. The FBI images of the 13 membranous stenoses of the IVC showed a sudden stenosis of the post-liver segment of the IVC. The Images of the 5 patients with a membranous obstruction of the IVC showed IVC thickening and an absence of blood signals in the post-hepatic segment of the IVC. The images of the 4 patients with the segmental thrombosis of the IVC showed abnormal and intermittent signals in the IVC. The images of the 6 patients with a simple hepatic vein obstruction showed obstructive hepatic veins. The images of the 6 patients with the stenosis of both the IVC and the hepatic veins showed the stenosis of the IVC, the thickening of the hepatic veins and the formation of a compensatory circulation within the liver. Lastly, the images of the 7 patients showed a combination of the IVC thrombosis with stenosis or with the obstruction of one or two hepatic veins. Conclusions An FBI can show a membranous stenosis, and an obstruction and thrombosis of the IVC. In addition, it can also demonstrate the thickening of the flexural hepatic vein and the development of intra-hepatic compensatory branches with slow blood flow. Thus, it can guide the puncturing and opening of the hepatic vein involved in an interventional therapy for BCS patients.     

置入下腔静脉滤器预防肺栓塞

目的探讨下肢深静脉血栓形成患者置入下腔静脉滤器预防肺动脉血栓的临床疗效。方法34例经彩超证实为下肢深静脉血栓患者,于下腔静脉内置入滤器,然后经患肢的足背静脉推注尿激酶进行溶栓治疗,观察疗效,并随访肺栓塞的发生情况。结果34例患者下腔静脉滤器均展开良好,无移位。其中,痊愈6例,显效24例,有效4例,无效0例。随访1-12月未发现肺动脉栓塞发生。结论下肢深静脉血栓形成患者置入下腔静脉滤器可有效预防肺栓塞的发生。     

Endovascular treatment of Budd-Chiari syndrome

Background  Budd-Chiari syndrome (BCS) is a posthepatic portal hypertension caused by the obstruction of the lumen of the hepatic veins or the proximal inferior vena cava (IVC). This study aimed to evaluate the clinical experience of interventional therapy for Budd-Chiari syndrome.

Methods  IVC venography was carried out first, the obliteration or stenosis in the IVC was opened or dilated with the hard guided wire or Rups100 puncture needle and balloon, then a stent was routinely implanted for the type of obliteration or stenosis.

Results  The procedure was successful in 821 out of 903 cases including IVC intervention in 760 cases, and hepatic vein intervention in 61 cases. An IVC stent was used in 517 cases and hepatic vein stent in 19 cases. There were no pulmonary embolisms, but acute renal failure occurred in eight cases, hepatic coma in two cases and acute heart failure in 43 cases. Two patients died in this group and five cases were complicated with acute IVC thrombosis. Follow up of 7 to 124 months was made in 679 cases with recurrence found in 59 cases.

Conclusions 　Interventional therapy is safe and effective with a fast recovery for most types of BCS. It is gradually becoming the first therapeutic choice.