改良法与传统法下肢静脉造影术的对照研究

目的对比使用静脉留置针经皮穿刺大隐静脉下肢静脉造影术(改良法),与静脉头皮针经皮穿刺足背浅静脉下肢静脉造影术(传统法)对下肢静脉病变的临床诊断价值。方法30例(34条患肢)先后采用传统法和改良法进行下肢静脉造影,并比较两者检查结果。结果改良法对髂总静脉、隐股静脉瓣膜和股浅静脉第一对瓣膜的显示率为100%,100%和91.18%;传统法分别为32.35%、73.53%和64.71%。在下肢浅静脉曲张和慢性肿胀患者中改良法诊断髂静脉受压综合征、隐股静脉瓣膜功能不全和股浅静脉第一对瓣膜功能不全的例数分别为14,25和21;传统法分别为3,14和12。两者比较均有显著性差异(P<0.05)。结论改良法下肢静脉造影术对发现是否存在髂静脉受压及对隐股静脉瓣膜和股浅静脉第一对瓣膜功能的判断比传统法具有优势,是对传统法静脉造影很好的补充,可部分替代经皮穿刺股静脉造影术。     

经皮静脉穿刺插管造影术及其价值(附20例23条肢体分析)

目的：探讨静脉穿刺插管造影术对下肢静脉疾病诊断的价值。方法：２０例２３条肢体行顺行深静脉造影和经皮静脉脉穿刺插管造影检查。结果：技术成功率为１００％。未发生并发症。２３条肢体中深静脉瓣膜功能不全的１４条，其中２条伴有交通静脉瓣膜功能不全。单纯交通静脉瓣膜功能不全１条。大隐静脉近端瓣膜功能不全３条。深静脉血栓形成后遗症２条。深静脉血栓形成２条。静脉瘤样病变１条。基本包括了常见下肢静脉疾病。结论：该法具有易穿刺插管，不易损伤瓣膜的优点。可满意显示髂－股－静脉，并能逐一观察每一对瓣膜的功能，同时也是髂－股－静脉血栓开通治疗的重要途径之一，弥补了其他造影术的不足。     

经膝部大隐静脉静脉造影术：一种新的静脉造影方法

作者设计了一种新的下肢静脉造影方法，即经膝部大隐静脉静脉造影术。在膝关节内侧暴露大隐静脉，直视下插入导管至隐股瓣的远端，经导管注入造影剂摄片。此法简便易行，能满意地了解下肢深静脉瓣膜功能，可避免大血管、神经的损伤和其他并发症的产生。     

湿润暴露疗法结合股浅静脉瓣膜修复术治疗下肢静脉性溃疡65例

目的:总结湿润暴露疗法(MEBT/MEBO)结合股浅静脉瓣膜修复术治疗下肢静脉性溃疡的疗效.方法:对65例75条肢体原发性下肢深静脉瓣膜功能不全伴下肢静脉性溃疡患者行股浅静脉瓣窦壁环包术,同时创面使用湿润烧伤膏(MEBO)换药治疗.结果:所有患者术后症状全部消失,下肢慢性溃疡最短愈合时间为16天,最长时间为72天.结论:湿润暴露疗法(MEBT/MEBO)结合股浅静脉瓣膜修复术治疗下肢溃疡效果显著.     

数字下肢静脉顺行造影的临床应用价值

目的:探讨数字成像结合下肢静脉造影对下肢静脉疾病的X线表现,评价其对临床的应用价值.材料和方法:回顾性分析87例(100侧肢体)下肢深静脉顺行造影的表现.结果:造影表现正常19侧肢体(19%)、单纯性下肢浅静脉瓣膜功能不全6侧肢体(7.4%)、交通静脉瓣膜功能不全9侧肢体(11%)、深静脉瓣膜功能不全49侧肢体(60.5%)、继发性静脉瓣膜功能不全6侧肢体(7.4%)、静脉瘤样改变6侧肢体(7.4%)、深静脉血栓形成6侧肢体(7.4%)和先天性静脉发育异常3侧肢体(3.7%).结论:下肢静脉顺行造影能较清晰地显示下肢静脉病变位置和范围及下肢静脉解剖变异.对明确诊断、选择合适的治疗方法以及疗效的观察等具有重要的临床意义和实用价值.     

下肢静脉造影在下肢静脉疾病诊治过程中的临床意义

目的:探讨下肢静脉造影在下肢静脉疾病诊治过程中的临床意义。方法:本组患者共1696例,对其中2123条下肢行下肢静脉顺行造影,同时行逆行下肢静脉造影452条,对造影表现进行分析。结果:2123条下肢造影成功率为100%。其中正常静脉11条(0.52%),单纯性浅静脉瓣膜关闭不全409条(19.27%),原发性深静脉瓣膜功能不全1120条(52.76%),深静脉血栓形成后综合征302条(14.23%),先天性下肢深静脉瓣膜发育不全症15条(0.71%),深静脉血栓形成65条(3.06%),先天性静脉畸形骨肥大综合征14例条(0.66%),左髂总静脉压迫综合征187条(8.81%)。结论:下肢静脉造影对下肢静脉疾病原发病因的明确诊断、选择恰当的治疗方法以及疗效的观察等具有重要的临床意义和实用价值。     

DSA在下肢深静脉造影中的临床应用

目的 探讨DSA 在下肢深静脉造影中的临床应用.方法 28例(33条)下肢静脉疾病的患者在DSA下行下肢深静脉顺、逆行造影,其中3例行经皮穿刺腘静脉插管造影.结果 根据主要X线表现将下肢静脉疾病分为:单纯性浅静脉瓣膜功能不全5条(15%),交通静脉瓣膜功能不全22条(67%),原发性深静脉瓣膜功能不全17条(52%),深静脉血栓形成8条(24%)和深静脉血栓形成后遗症3条(9%).根据深静脉逆流程度分为:Ⅰ级5条,Ⅱ级7条,Ⅲ级3条,Ⅳ级1条.结论 在DSA下行下肢深静脉造影能清楚地显示病变的部位、形态和范围,为临床治疗方案的选择提供可靠依据,值得推广.     

下肢静脉高压症顺行性静脉造影的诊断意义

本文对临床上有下肢静脉高压症的56例病人,共76条下肢,进行了顺行性静脉造影的X线研究。其中对12条下肢做了经皮腘静脉造影检查。作者认为:(1)下肢静脉高压除因下肢静脉血栓形成外,下肢深静脉瓣膜功能不全是其另一个主要原因。(2)经皮腘静脉造影是检测下肢深静脉瓣膜功能的有效、准确的方法。(3)下肢静脉造影的联合应用,在检查下肢静脉高压中具有科学性和准确性。     

经皮腘静脉插管造影术的临床应用

作者对37例患者的37条下肢行经皮腘静脉插管造影术,认为此造影不但可以清晰地显示髂—股—腘静脉段。而且能够逐一测试这段静脉中每一对瓣膜的功能,弥补了顺行和逆行造影术的不足。用此方法并能逐一检测双股静脉畸形的每一支,对双股静脉畸形的原发性深静脉瓣膜功能不全做出明确诊断。     

数字化X线下肢静脉造影录像在下肢静脉疾病诊断中的临床应用

目的探讨数字化X线下下肢静脉造影录像在下肢静脉疾病中的应用价值。方法分析50例患者53条下肢在数字化X线下行下肢静脉造影录像资料。结果 53条下肢静脉造影成功率100%。其中正常静脉0条,单纯性隐股静脉瓣膜关闭不全1条(1.89%),原发性深静脉瓣膜功能不全17条(32.07%),深静脉血栓形成14条(26.41%),深静脉血栓形成后综合征5条(9.43),左髂总静脉压迫综合征14条(26.41%),先天性静脉发育异常和静脉瘤样病变2条(3.77%)。结论数字化X线下下肢静脉造影录像能更动态、直观的观察记录下肢静脉疾病原发病因有重要价值。     

Deep venous thrombosis of the lower extremity: US evaluation

The sensitivity of duplex ultrasonography (US) for detecting deep venous thrombosis of the lower extremity was compared with that of venography in a prospective study of 54 patients. Doppler analysis of the common femoral vein and US imaging of the deep venous system from the common femoral vein to the popliteal vein was performed. Common femoral vein response to the Valsalva maneuver was recorded. Sonographically visible thrombi and abnormal vein compressibility were 91% sensitive for the common femoral vein, and 94% sensitive for the superficial femoral or popliteal veins, with no false-positive examinations. Abnormal Doppler flow and abnormal response of the common femoral vein to the Valsalva maneuver enabled thrombi to be detected only in the common femoral and iliac veins. Combined data allowed accurate diagnoses in all patients with deep venous thrombosis proximal to the deep calf veins. US should be the screening examination of choice for evaluating patients with suspected lower extremity deep venous thrombosis.     

顺行性下肢深静脉造影表现及临床意义

目的：评价顺行性下肢深静脉造影对下肢静脉疾病诊断、分类及治疗的临床价值。材料与方法：327例病人（447条病肢）采用顺行性下肢深静脉造影，适时点片。结果：原发性深静脉瓣膜功能不全226条（59。5％），深静脉血栓形成后综合征110条（24．6％），原发性浅静脉瓣膜功能不全26条（5．9％），急性深静脉血栓形成23条（5．1％），先天性静脉发育异常13条（2．9％），静脉瘤样病变7条（1．5％）。结论：顺行性下肢深静脉造影对下肢静脉疾病的诊断、分类、治疗有重大指导意义。     

多层螺旋CT血管成像与DSA对照诊断下肢静脉阻塞性病变

目的探讨多层螺旋CT血管成像(multi-slice CT angiography,MSCTA)在下肢静脉阻塞性病变中的应用价值。方法对32例临床疑有下肢静脉阻塞性病变患者行16层螺旋CT血管成像及血管三维重建,并进行DSA检查,结合临床资料分析CTA技术及其在下肢静脉阻塞性病变中的应用价值。结果32例疑诊下肢静脉阻塞性病变患者,MSCTA诊断髂静脉受压综合征19例,其中左侧髂总静脉受压16例,右侧髂总静脉或其分支受压3例。下肢深静脉血栓形成9例,其中左下肢2例,右下肢5例,双下肢2例。左侧腹股沟区囊肿压迫左侧髂外静脉1例。单纯左下肢浅静脉曲张1例。以上30例CT诊断结果均与DSA结果相符合。MSCTA诊断右侧股腘静脉扩张1例,未见异常1例,该2例DSA均提示下肢深静脉瓣膜功能不全。结论MSCTA对下肢静脉阻塞性病变的诊断有较高的临床应用价值。     

Thrombolysis for lower extremity deep venous thrombosis

Catheter-directed thrombolysis (CDT) has been proposed as an alternative mode of therapy to anticoagulation in patients with massive, symptomatic deep vein thrombosis of the extremity. The major goal of therapy is to rapidly restore venous blood flow, reduce the pain and edema of the extremity, preserve venous valve function, and reduce chronic symptoms related to chronic venous hypertension (postthrombotic syndrome). In patients with iliofemoral deep venous thrombosis (DVT) standard angiographic techniques are used to instrument a lower extremity vein (popliteal) and venography is performed followed by catheter-directed infusion of a plasminogen activator directly into the thrombus. Following lytic infusion, the interventionalist must evaluate the venous drainage to determine if there is an anatomic lesion that requires further endovascular treatment (eg, iliac vein compression syndrome). Posttreatment therapy usually consists of warfarin therapy and venous compression stockings for at least 3 to 6 months. The purpose of this article is to review the technical approach used in treating iliofemoral DVT and highlight the hurdles that face interventionalists in attempting to broaden this procedure to most types of lower extremity DVT.     

数字化顺行性下肢静脉造影的诊断价值

目的用数字化顺行性下肢造影的应用情况,评价其诊断价值。方法采用德国SiemensAx-iomIeonosR200Fleom数字化x线胃肠机对2011年12月至2013年3月158例（172条）下肢进行顺行性静脉造影检查。结果单纯性下肢浅静脉瓣膜关闭功能不全80条（46．5％）,交通静脉瓣膜关闭功能不全12条（7．0％）,深静脉瓣膜关闭功能不全33条（19．8％）,下肢深静脉血栓36条（20．9％）,髂静脉受压综合征5条（2．9％）,静脉畸形骨肥大综合征2条（1．2％）,静脉瘤3条（1．7％）。结论数字化下肢静脉造影是一种安全易行、图像清晰度高、对比度好、分辨率高、检查结果直观、确切的检查方法,能给临床明确诊断及治疗提供可靠的影像诊断依据。     

下肢静脉曲张患者行深静脉造影方法的改良

目的 提高下肢静脉曲张患者在下肢静脉造影中深静脉的显示率,改善图像质量.方法 对67例(71条患肢)下肢静脉曲张患者,先后使用止血带束扎踝上浅静脉(单纯束扎法)和使用血压计臂带加压压迫曲张静脉(联合压迫法),再进行顺行性下肢深静脉造影.结果 造影结果显示,单纯束扎法进行顺行造影中,深静脉显示率为64.79％;髂静脉图像优质率为36.62％;在联合压迫法顺行造影中,深静脉显示率为88.73％,髂静脉图像优质率为66.20％;两种方法造影结果经统计学分析有显著性差异(P＜0.05).结论 在下肢静脉严重曲张患者中,使用血压计臂带加压压迫下肢曲张静脉部位后进行下肢顺行静脉造影,有助于下肢深静脉显示.     

Deep venous thrombosis: comparison of indirect multidetector CT venography and sonography of lower extremities in 26 patients

OBJECTIVE: To compare the accuracy of indirect mutidetector row computed tomographic (MDCT) venography with lower extremity venous sonography for the diagnosis of femoropopliteal deep venous thrombosis (DVT), and to determine the frequency and location of DVT at MDCT venography. MATERIALS AND METHODS: Twenty-six consecutive patients suspected of having pulmonary embolism (PE) underwent both combined MDCT venography and MDCT pulmonary angiography and lower extremity venous sonography. Indirect MDCT venography was acquired from the upper calves to the mid-abdomen following MDCT pulmonary angiography. The CT venographic findings were compared with those of sonography for the diagnosis of femoropopliteal DVT. All CT scans were also reviewed for the frequency and location of DVT. RESULTS: Indirect MDCT venography disclosed DVT in 19 patients, and 12 of whom also had PE. Seventeen patients with thrombosis in the femoropopliteal veins were identified in both indirect MDCT venography and sonography. The sensitivity and specificity of indirect MDCT venography for femoropopliteal DVT, as compared with sonography, were both 100%. In one patient DVT in the superficial femoral vein was detected using only indirect MDCT venography. MDCT venography also showed superior extension of femoropopliteal DVT to the inferior vena cava and iliac veins in four patients and thrombosis isolated to the inferior vena cava and common iliac vein thrombosis in one patient. CONCLUSIONS: Indirect MDCT venography is as accurate as sonography in the diagnosis of femoropopliteal DVT. MDCT venography can further reveal thrombus in large pelvis veins and the inferior vena cava, an important advantage over sonographic screening for DVT.     

Deep venous thrombosis evaluation with limited-flip-angle, gradient- refocused MR imaging: preliminary experience

Sixteen patients (17 lower extremities) were prospectively examined with venography and limited-flip-angle, gradient-refocused magnetic resonance (MR) imaging for the presence or absence of deep venous thrombosis. Thrombosed vessels showed decreased-to-absent signal intensity, while patent vessels had high signal intensity. In 16 of 17 extremities, MR images allowed accurate detection and localization of the thrombi found with venography. In the remaining extremity, MR imaging allowed correct identification of thrombus in the iliac and femoral veins but incorrectly demonstrated clot in the calf and popliteal veins. MR imaging with limited-flip-angle, gradient-refocused pulse sequences appears to be a sensitive, noninvasive means of detecting deep venous thrombosis.     

Direct contrast-enhanced MR venography in the diagnosis of May-Thurner Syndrome

Visualization of lower extremity veins with MR venography still needs improvement. The latest advancement is direct contrast-enhanced 3D MR venography which is based on display of venous system during direct injection of paramagnetic extracellular contrast agent into pedal veins. We used automated injection of contrast agent with a power injector makings this application simpler and faster, achieved to show the iliac vein compression syndrome and post-thrombotic changes of the left iliac and femoral veins.