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1.
Pancreas Transplant Venous Thrombosis: Role of Endovascular Interventions for Graft Salvage 总被引:1,自引:0,他引:1
Andrew H. Stockland Darrin L. Willingham Ricardo Paz-Fumagalli Hani P. Grewal J. Mark McKinney Christopher B. Hughes Eric M. Walser 《Cardiovascular and interventional radiology》2009,32(2):279-283
Venous thrombosis of pancreas transplant allografts often leads to graft loss. We evaluated the efficacy of emergent endovascular
techniques to salvage thrombosed pancreatic allografts in a series of six patients. Of the 76 pancreas transplants performed
between 2002 and 2006, six patients were diagnosed with venous thrombosis on MRI between 2 and 28 days posttransplant (mean,
9 days). Five patients were systemic-enteric (donor portal vein anastomosis to recipient iliac vein) and one patient was portal-enteric
(donor portal vein anastomosis to recipient superior mesenteric vein). Conventional venography confirmed the diagnosis of
venous thrombosis in all patients. One patient was treated with catheter-directed venous thrombolysis and balloon thrombectomy.
Another patient was treated with rheolytic thrombectomy alone. The remaining four patients were treated with a combination
of these mechanical and thrombolytic techniques. Completion venography revealed >50% clot reduction and resumption of venous
drainage in all patients. One patient required additional intervention 16 days later for recurrent thrombosis. Two patients
required metal stent placement for anastomotic stenoses or kinks. One patient required pancreatectomy 36 h after attempted
salvage secondary to a major hemorrhage and graft necrosis. Two patients recovered pancreatic function initially but lost
graft function at 8 and 14 months, respectively, from severe chronic rejection. Patient survival was 100%, long-term graft
survival was 50%, rethrombosis rate was 16.6%, and graft loss from rejection was 33%. In conclusion, early recognition and
treatment of venous thrombosis after pancreas transplantation has acceptable morbidity and no mortality using short-term endovascular
pharmacomechanical therapy. 相似文献
2.
Takuji Yamagami Rika Yoshimatsu Osamu Tanaka Hiroshi Miura Tsunehiko Nishimura 《Cardiovascular and interventional radiology》2010,33(6):1223-1229
This study was designed to evaluate the usefulness of endovascular thrombolysis using monteplase for deep venous thrombosis
(DVT). Between December 2005 and October 2009, at our institution nine endovascular thrombolysis treatments with monteplase
were performed for symptomatic DVT in eight patients (6 women, 2 men; mean age, 56 (range, 15–80) years). In all, systemic
anticoagulation administered by the peripheral intravenous route with heparin and/or thrombolysis with urokinase followed
by anticoagulation with orally administered warfarin had been performed, and subsequently six endovascular treatments without
monteplase were administered. However, DVT persisted, and endovascular treatments with monteplase were tried. In six (67%)
of the nine procedures, DVT completely or almost completely disappeared after endovascular thrombolysis with monteplase. Mean
dose of monteplase used was 2,170,000 IU. There was only one procedure-related complication. In one patient, just after thrombolysis
with monteplase, bleeding at the puncture site and gingival bleeding occurred. Bleeding was stopped by manual astriction only.
Endovascular thrombolysis with monteplase may be an effective treatment for DVT, even in cases resistant to traditional systemic
anticoagulation and thrombolysis and endovascular procedures without monteplase. 相似文献
3.
深静脉血栓的血管内溶栓治疗 总被引:9,自引:2,他引:7
通过对深静脉血栓的血管内溶栓治疗分析,提供一种有效的治疗静脉血栓的新方法。本组7例,左髂总静脉血栓4例,左髂外静脉2例,右髂外静脉1例,7例均先插管逆,顺行静脉造影确定血栓长度及病变程度。 相似文献
4.
Peter D. Thurley Michael J. Glasby John G. Pollock Peter Bungay Mario De Nunzio Amin M. El-Tahir John W. Quarmby 《Cardiovascular and interventional radiology》2010,33(4):840-843
Graft thrombosis rates after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms vary widely in published series.
When thrombosis does occur, it usually involves a single limb and occurs within 3 months of stent-graft insertion. If the
entire endoprosthesis is thrombosed, treatment may be challenging because femoro-femoral crossover graft insertion is not
an option and a greater volume of thrombus is present, thus making thrombolysis more difficult. We present two cases of delayed
thrombosis after EVAR involving the entire stent-graft. These were successfully treated by a combined surgical and endovascular
technique, and patency has been maintained in both cases to date. 相似文献
5.
《Journal of vascular and interventional radiology : JVIR》2014,25(8):1158-1164
PurposeTo evaluate the technical feasibility and safety of percutaneous endovascular thrombolysis for extremity deep venous thrombosis (DVT) in children < 24 months old.Materials and MethodsA retrospective chart review of a clinical and imaging database was performed for pediatric patients who underwent endovascular therapy for DVT between January 2010 and July 2013. Indications, techniques, technical and clinical success, and complications were reviewed. Techniques for thrombolysis included catheter-directed therapy (CDT) using alteplase infusion via a multi–side hole catheter, mechanical thrombectomy, and angioplasty. Short-term outcomes were assessed using surgical and imaging follow-up examinations for patency of the targeted vessel. Patients included 11 children (mean age, 9 mo; range, 3 wk–23 mo) who consecutively underwent endovascular thrombolysis for upper extremity (n = 6) or lower extremity (n = 5) DVT. The most common indication was preservation of venous access for future cardiac surgery or medical therapy.ResultsThe most common risk factor was the presence of a central venous catheter (10 of 11 patients). All patients with upper extremity DVT had congenital heart disease. CDT and angioplasty were performed in all patients. Venous patency was established in all patients. A grade III (95%–100%) thrombolysis response was achieved in seven patients, and a grade II (50%–95%) thrombolysis response was achieved in four patients. A major complication of pulmonary embolism occurred in one patient with upper extremity thrombolysis and was managed by intravenous systemic alteplase and heparin. No recurrence of thrombosis was found on average follow-up of 11.8 months (range, 1–41 mo).ConclusionsPercutaneous endovascular thrombolysis for extremity DVT is safe and technically feasible in children < 24 months old. 相似文献
6.
Anders Vik Pål Andre Holme Kulbir Singh Eric Dorenberg Kåre Christian Nordhus Satish Kumar John-Bjarne Hansen 《Cardiovascular and interventional radiology》2009,32(5):980-987
Traditional anticoagulant treatment of deep venous thrombosis (DVT) in the upper extremities (UEDVT) is associated with a
relatively high incidence of postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) for UEDVT would provide efficient
thrombolysis with less subsequent PTS than during traditional anticoagulation. Primary efficacy, complications, and long-term
results after CDT are reported in a retrospective cohort (2002–2007) of patients (n = 30) with DVT in the upper extremities. PTS was assessed by a modified Villalta scale. UEDVT was unprovoked in 11 (37%)
cases and effort related in 9 (30%) cases. The median duration of symptoms prior to CDT was 7.0 days (range, 1–30); median
duration of thrombolysis treatment, 70 h (range, 24–264 h); and the median amount of rt-PA infused during CDT, 52 mg (range,
19–225 mg). Major bleeding was registered in three (9%) patients, and CDT was stopped prematurely in three patients due to
local hematoma. No intracerebral bleeding, clinical pulmonary embolism, or deaths occurred during treatment. Grade II (>50%)
or III (>90%) lysis was present in 29 patients (97%) at the end of CDT. Bleeding complications increased by each day of delay
from the debut of symptoms to the start of treatment (OR, 1.20; 95% CI, 1.01–1.42). At follow-up (n = 29; median, 21 months; range, 5–58 months), 11 (38%) patients had occluded veins, whereas 18 (62%) had patent veins. However,
stenosis of varying severity was present in eight of those with a patent vein. No patients had severe PTS, whereas six (21%)
experienced mild PTS. In conclusion, our retrospective cohort study of patients with UEDVT showed that treatment restored
venous drainage, with a subsequent low frequency of mild PTS at follow-up. Early intervention with CDT prevented bleeding
complications. 相似文献
7.
8.
Raphael Yoo Ahmad I. Alomari Raja Shaikh Scott L. Davis Michael A. Ferguson Kashayar Vakili Heung-Bae Kim Gulraiz Chaudry 《Journal of vascular and interventional radiology : JVIR》2017,28(8):1184-1188
A 5-year-old boy with midaortic syndrome who had undergone aortic bypass and bilateral renal artery grafts presented to the emergency department 1 year after surgery with symptoms of nausea, vomiting, and abdominal pain. Because of delay in diagnosis of bilateral renal artery thrombosis, his condition progressed to anuric renal failure. He underwent catheter-directed thrombolysis 7 days after presentation with administration of tissue plasminogen activator and heparin infusion over a 24-hour period. There was successful resolution of thrombus and complete recovery of renal function to baseline. The patient had normal renal function at 6-month follow-up. 相似文献
9.
《Journal of vascular and interventional radiology : JVIR》2022,33(3):249-254.e1
An ovine iliac vein thrombosis model was devised to test a wall-contacting rotational thrombectomy device. Thrombosis was successfully induced in 9 sheep with an average clot length of 31 mm ± 12 and >60% vessel occlusion on angiography. The thrombus was subsequently removed, maintaining normal intraoperative pulmonary arterial pressure (5.9 mm Hg ± 3.6) and complete distal reperfusion after thrombectomy. Additionally, the sheep were without signs of vascular trauma or embolic complications on gross necropsy and histopathologic analysis. The findings from this study support the use of an ovine iliac deep vein thrombosis model for testing of a lower extremity thrombectomy device. 相似文献
10.
目的 探讨经导管局部溶栓治疗髂 股静脉血栓的效果及临床应用中的有关问题。资料与方法 对 5 8例髂 股静脉血栓形成患者 (病程 <4周 4 5例 ,>4周 13例 ) ,采取经导管血栓局部灌注尿激酶 ,尿激酶先团注2 5 0 0 0 0U ,然后以 12 5 0 0 0~ 15 0 0 0 0U/h持续灌注。结果 全组溶栓治疗时间 4~ 5 6h ,平均 36h ,尿激酶用量75 0 0 0 0~ 72 5 0 0 0 0U ,平均 4 70 0 0 0 0U。阻塞段完全开通 (残存狭窄率 <30 % )者 30例 ,部分开通者 2 3例 ,无效 5例 ,有效率达 91.4 %。对残存狭窄率 >30 %的 2 3例 ,14例行经皮球囊血管成形术 (PTA)治疗 ,9例行PTA及内支架治疗。 6例溶栓前放置下腔静脉过滤器。本组无严重并发症及肺栓塞发生。结论 经导管血栓局部灌注尿激酶是治疗髂 股静脉血栓的安全、有效方法。溶栓术后继续肝素全身抗凝治疗可增强溶栓疗效 相似文献
11.
目的 评价经腘静脉置管溶栓治疗脑梗死合并急性下肢深静脉血栓形成患者的临床应用价值.方法 脑梗死合并急性下肢深静脉血栓患者34例,按患肢肌力高低分为两组,肌力较低组(0~Ⅱ级)23例,肌力较高组(Ⅲ~Ⅳ级)11例.所有患者在B超引导下经腘静脉置入溶栓导管,经溶栓导管持续泵人尿激酶10~14天,同时行抗凝治疗.监测凝血酶原时间、颅脑CT.结果 溶栓疗效显著者30例,其中治愈12例,显效18例,有效4例,显效率88.2%,总有效率为100%,肌力较高组血管完全再通率高.所有病例均无肺动脉栓塞症及严重出血并发症.随访期间2例复发,均为肌力较低患者.结论 对脑梗死伴下肢深静脉血栓形成的患者行置管溶栓治疗安全,效果良好.患肢肌力较低者易复发,需注意随访. 相似文献
12.
脑梗死患者急性下肢深静脉血栓的溶栓治疗 总被引:1,自引:0,他引:1
目的 评价脑梗死患者急性下肢深静脉血栓形成介入溶栓治疗的可行性. 资料与方法 脑梗死伴发急性下肢深静脉血栓患者32例,按患肢肌力高低分为两组,肌力较低组18例,肌力较高组14例.所有患者行腘动脉留置导管, 灌注尿激酶溶栓.检测凝血酶原时间、头颅CT检查. 结果 临床症状缓解率为100%,溶栓时间、溶栓药物剂量肌力较低组﹥肌力较高组.1个月后多普勒超声检查或静脉造影检查有效再通率为100%,其中血管完全再通率肌力较低组﹤肌力较高组.溶栓后CT发现无症状脑出血1例.随访期间2例复发,均为肌力较低患者. 结论 对伴脑梗死的深静脉血栓患者行低剂量溶栓治疗安全、有效.患肢肌力较低者易复发,需注意随访. 相似文献
13.
Izaki K Yamaguchi M Matsumoto I Shinzeki M Ku Y Sugimura K Sugimoto K 《Cardiovascular and interventional radiology》2011,34(3):650-653
A 57-year-old woman with a history of diabetes mellitus underwent simultaneous pancreas–kidney transplantation. The pancreaticoduodenal
graft was implanted in the right iliac fossa. The donor’s portal vein was anastomosed to the recipient’s inferior vena cava
(IVC). Seven days after the surgery, a thrombus was detected in the graft veins. Percutaneous thrombolysis was immediately
performed; however, venous congestion was still present. We therefore attempted selective embolectomy using a Fogarty Thru-Lumen
Catheter. Thrombi were directed from the graft veins toward the IVC and captured in the IVC filter with complete elimination
of the thrombus without any major complications. We present our technique for the successful treatment of pancreas graft thrombosis
within a short time period by percutaneous selective embolectomy using a Fogarty Thru-Lumen Catheter. 相似文献
14.
Sarfraz Ahmed Nazir Arul Ganeshan Sheraz Nazir Raman Uberoi 《Cardiovascular and interventional radiology》2009,32(5):861-876
Lower limb deep vein thrombosis (DVT) is a common cause of significant morbidity and mortality. Systemic anticoagulation therapy
is the mainstay of conventional treatment instituted by most physicians for the management of DVT. This has proven efficacy
in the prevention of thrombus extension and reduction in the incidence of pulmonary embolism and rethrombosis. Unfortunately,
especially in patients with severe and extensive iliofemoral DVT, standard treatment may not be entirely adequate. This is
because a considerable proportion of these patients eventually develops postthrombotic syndrome. This is characterized by
chronic extremity pain and trophic skin changes, edema, ulceration, and venous claudication. Recent interest in endovascular
technologies has led to the development of an assortment of minimally invasive, catheter-based strategies to deal with venous
thrombus. These comprise catheter-directed thrombolysis, percutaneous mechanical thrombectomy devices, adjuvant venous angioplasty
and stenting, and inferior vena cava filters. This article reviews these technologies and discusses their current role as
percutaneous treatment strategies for venous thrombotic conditions. 相似文献
15.
下肢深静脉血栓形成的时间与导管局部溶栓疗效关系 总被引:4,自引:1,他引:3
目的探讨经导管局部溶栓治疗下肢深静脉血栓形成(DVT)的溶栓时间与疗效关系。方法56例患者,病程1~14 d者22例(A组),病程15~40 d者34例(B组)。全部患者均经右颈内静脉途径置入导管行尿激酶溶栓治疗。结果A组:导管溶栓时间为5~11 d,平均为(7.1±5.9)d;血栓完全溶解19例(86.4%),部分溶解3例(13.6%)。B组:导管溶栓时间为7~18 d,平均为(11.3±7.2)d,显著高于A组(P<0.05),血栓完全溶解28例(82.4%),部分溶解6例(17.6%),2组比较差异无统计学意义(P>0.05)。结论对于病程较长的下肢DVT,延长导管溶栓时间,可获得较好的疗效。 相似文献
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17.
《Journal of vascular and interventional radiology : JVIR》2022,33(3):255-261.e2
PurposeTo characterize an ovine endovascular radiofrequency (RF) ablation-based venous stenosis and thrombosis model for studying venous biomechanics and response to intervention.Materials and MethodsUnilateral short-segment (n = 2) or long-segment (n = 6) iliac vein stenoses were created in 8 adult sheep using an endovenous RF ablation technique. Angiographic assessment was performed at baseline, immediately after venous stenosis creation, and after 2-week (n = 6) or 3-month (n = 2) survival. Stenosed iliac veins and the contralateral healthy controls were harvested for histological and biomechanical assessment.ResultsAt follow-up, the short-segment RF ablation group showed stable stenosis without occlusion. The long-segment group showed complete venous occlusion/thrombosis with the formation of collateral veins. Stenosed veins showed significant wall thickening (0.28 vs 0.16 mm, P = .0175) and confluent collagen deposition compared with the healthy controls. Subacute nonadherent thrombi were apparent at 2 weeks, which were replaced by fibrous luminal obliteration with channels of recanalization at 3 months. Stenosed veins demonstrated increased longitudinal stiffness (448.5 ± 5.4 vs 314.6 ± 1.5 kPa, P < .0001) and decreased circumferential stiffness (140.8 ± 2.6 vs 246.0 ± 1.6 kPa, P < .0001) compared with the healthy controls.ConclusionEndovenous RF ablation is a reliable technique for creating venous stenosis and thrombosis in a large animal model with histological and biomechanical attributes similar to those seen in humans. This platform can facilitate understanding of venous biomechanics and testing of venous-specific devices and interventions. 相似文献
18.
Xiaoqin Zhang Qingshuai Ren Xuemei Jiang Jianming Sun Jianping Gong Bo Tang Yikuan Chen 《Cardiovascular and interventional radiology》2014,37(4):958-968
Purpose
Catheter-directed thrombolysis (CDT) is effective for acute iliofemoral deep venous thrombosis (DVT), but CDT remains partially effective for subacute DVT. The aim of this study was to conduct a prospective randomized controlled single-centre clinical trial to compare CDT alone with CDT with additional balloon dilatation for the treatment of iliofemoral DVT.Methods
The trial was performed between February 2007 and January 2011. Iliofemoral DVT patients lacking effective therapy before enrollment were randomly assigned either to CDT (control group) or to CDT with additional balloon dilatation (intervention group). Insufficiency Epidemiological and Economic Study-Quality of Life (VEINES-QOL), Severity of Venous Lower Limb Symptoms (VEINES-Sym), 36-Item Short-Form Health Survey (SF-36), and Villalta scores were obtained at scheduled follow-up.Results
Seven hundred twenty-two patients were screened, and 386 eligible patients were randomized. No significant difference for mean total Villalta score was observed between the intervention group (4.20 ± 3.05) and the control group (4.89 ± 3.45). However, post hoc analysis of the scores in subacute patients showed significant differences between the intervention group and the control group from 1 month (6.79 ± 4.23, 8.28 ± 5.03, P = 0.02) to 24 months (4.21 ± 3.08, 5.67 ± 3.71, P = 0.006). A significant difference was also observed in subacute patients at the end of follow-up for VEINES-QOL/Sym (52.87 ± 6.52, 50.31 ± 6.07, P = 0.009; 51.87 ± 6.37, 49.72 ± 5.96, P = 0.02) and SF-36 PCS/MCS (45.02 ± 12.07, 41.13 ± 11.68, P = 0.03; 53.26 ± 11.43, 49.50 ± 11.06, P = 0.03).Conclusion
Subacute iliofemoral DVT patients lacking effective therapy during acute phase, might receive more benefits from CDT with additional balloon dilatation. However, CDT alone is highly effective for acute patients. 相似文献19.
Binbin Gao Jingyong Zhang Xuejun Wu Zonglin Han Hua Zhou Dianning Dong Xing Jin 《Korean journal of radiology》2011,12(1):97-106