经腘静脉置管接触性溶栓治疗急性下肢深静脉血栓形成应用价值研究

目的探讨经患侧腘静脉置管接触性溶栓(CDT)治疗急性下肢深静脉血栓形成(DVT)的临床疗效。方法回顾性分析自2012年3月至2017年3月收治的39例应用经患侧腘静脉CDT治疗急性DVT患者的临床资料。所有患者均在腔静脉滤器保护下经患侧腘静脉置管CDT。记录置管成功率,健、患肢周径差值,静脉血栓评分,静脉再通率,深静脉瓣膜保存率,介入治疗并发症与下肢深静脉血栓形成后综合征(PTS)的发生率等指标并评价疗效。结果所有患者均穿刺置管成功,置管成功率为100.0%(39/39)。患者治疗前后的健、患肢周径差值分别为(6.12±1.03)cm与(2.55±0.76)cm,差异有统计学意义(P<0.05),肢体肿胀消退明显。患者治疗前后静脉血栓评分为(5.73±0.94)分与(2.13±1.60)分,差异有统计学意义(P<0.05),血栓消融明显,静脉再通率为(64.23%±16.21%)。39例患者中,1例患者出现置管处炎症,1例患者出现穿刺处血肿,1例患者溶栓后出现髂静脉狭窄并行髂静脉支架植入术治疗,即介入治疗并发症的发生率为7.7%(3/39)。随访6~12个月,34例患者完成随访,随访率为87.2%(34/39),无DVT复发与肺栓塞发生。深静脉瓣膜保存率为(76.14%±9.15%),PTS的发生率为15.4%(6/39)。结论应用经患侧腘静脉CDT治疗急性DVT安全有效。     

经动脉序贯静脉置管溶栓治疗急性混合型下肢深静脉血栓26例的初步临床疗效观察

目的评价经动脉序贯静脉置管溶栓治疗急性混合型下肢深静脉血栓（lower extremity deep vein thrombosis,LEDVT）的安全性和有效性。 方法回顾性分析26例急性混合型LEDVT患者的临床资料。患者术前置入下腔静脉滤器,穿刺左侧肱动脉于患侧髂动脉置管溶栓,2～3 d后复查造影并穿刺患侧腘静脉行球囊扩张（percutaneous transluminal angioplasty,PTA）+手动抽栓（percutaneous mechanical thrombectomy,PMT）+置管溶栓（catheter directed thrombolysis,CDT）。观察血栓清除情况、患侧下肢周径变化情况及溶栓并发症等。 结果26例患者经动脉置管溶栓后24例（92.31%）腘静脉及膝下段深静脉血栓大部分溶解;之后行PTA+PMT+CDT操作1次者17例（65.39%）,操作2次者7例（26.92%）,操作3次后置入髂静脉支架者2例（7.69%）。血栓清除率Ⅲ级者22例（84.62%）,Ⅱ级者2例（7.69%）,I级者2例（7.69%）。治疗前膝上周径与健侧差值为（5.02±2.29）cm,治疗后差值为（0.74±0.18）cm,两者比较具有显著的统计学差异（t=7.601,P<0.001）。26例溶栓治疗无严重并发症。 结论经髂动脉置管溶栓序贯腘静脉PTA+PMT+CDT对于急性混合型LEDVT治疗安全有效。     

置管溶栓治疗下腔静脉血栓：附21例报道

目的探讨置管溶栓（catheter-directed thrombolysis,CDT）治疗下腔静脉血栓的安全性和疗效。 方法回顾性分析21例经CDT治疗的下腔静脉血栓患者的临床及影像资料。 结果21例患者均经静脉造影诊断为下腔静脉血栓,同时伴有下肢深静脉血栓。其中下肢深静脉血栓向上延续导致的下腔静脉血栓18例,下腔静脉滤器导致的下腔静脉血栓3例。21例患者均在下腔静脉滤器的保护下成功进行CDT治疗,其中7例患者伴有髂静脉压迫综合征,给予髂静脉支架治疗。随访3～48个月,1例肿瘤患者CDT术后2周再次出现下肢深静脉血栓,给予加强抗凝治疗后好转,其他患者无血栓复发,所有患者无严重并发症的发生。 结论下肢深静脉血栓和下腔静脉滤器均会导致下腔静脉血栓。在下腔静脉滤器的保护下,CDT治疗下腔静脉血栓是安全有效的方法。     

超声引导下置管溶栓治疗下肢深静脉血栓

目的 探讨超声引导下经皮置管溶栓治疗下肢深静脉血栓形成(DVT)的临床应用价值.方法 自2009年9月至2011年9月共收治下肢DVT患者34例,均采用下腔静脉滤器置入后,患肢在超声引导下经皮置管,持续导管内给予溶栓药物尿激酶50 万u/d和肝素5 000 u/d,交替使用.其中2例患者合并下腔静脉血栓,采用经颈静脉途径释放下腔静脉滤器;2例患者采用大隐静脉置管;其余均采用经皮腘静脉置管.结果 所有患者均置管成功,放置溶栓导管5 ～ 7 d.27例患者术后下肢肿胀基本消失,活动能力明显改善.5例患者活动后仍有较明显乏力和沉重感.1例患者术后3个月复发,再次置管后好转.1例患者术后6个月复发合并健侧下肢DVT,采用外周血管溶栓治疗.所有患者均采用DSA了解溶栓情况,26例患者髂股静脉术后连续性通畅,8例患者阶段性通畅.结论 超声引导下经皮置管溶栓治疗具有创伤小、定位准确、药物剂量个人化以及溶栓率高等优点,是治疗DVT的有效方法.     

介入治疗急性左髂股静脉血栓——先溶栓或先扩张

目的 评价两种不同介入治疗程序(先溶栓或先扩张)在治疗急性左髂股静脉血栓中的近期疗效和并发症发生率的差异.方法 将45例急性左下肢中央型深静脉血栓患者分为两组.A组21例,经左侧胭静脉插入溶栓导管到髂股静脉血栓内,行导管溶栓,治疗后如有残留狭窄,再行球囊扩张或支架置人.B组24例,经左侧胭静脉置鞘,对左侧髂静脉和血栓先...     

两种顺行置管方式溶栓治疗急性髂股静脉血栓的对照研究

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46例经造影明确诊断的急性髂股静脉血栓患者,随机分为2组,经患肢大隐静脉入路置管溶栓的为A组(21例),经患肢腘静脉入路置管溶栓的为B组(25例)。对两组患者总体治疗效果、静脉通畅度、患肢消肿率、穿刺置管消耗时间及治疗期间并发症发生率等进行观察比较。结果总体有效率A组95.2%;B组96.0%;消肿率A组(86.6±20.0)%,B组(85.7±14.6)%;静脉通畅度A组(57.9±19.4)%,B组(57.7±19.3)%。两组之间疗效差异无统计学意义(P>0.05)。A组穿刺消耗时间少于B组(P<0.05),大隐静脉穿刺难度低于腘静脉。大隐静脉置管的并发症发生率低于腘静脉置管(P<0.05)。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简单易行、有效的方法。     

经大隐静脉穿刺置管溶栓治疗急性期髂股静脉血栓形成

目的:探讨经大隐静脉入路置管溶栓治疗髂股静脉血栓形成的应用价值。方法:对18例急性期髂股静脉血栓形成的患者在下腔静脉滤器植入术前提下,经大隐静脉入路置管溶栓治疗。结果:18例患者经大隐静脉穿刺成功置管,技术成功率为100%,治疗有效率为100%。置管期间无不良反应及并发症发生;平均住院时间为12.5d。结论:经大隐静脉入路置管溶栓介入治疗急性期髂股静脉血栓操作简便,经济实用,安全有效。     

急性下肢深静脉血栓形成腔内治疗的中远期疗效观察

目的：评估血管腔内治疗急性下肢深静脉血栓形成（DVT）的中远期疗效。 方法：选取2007年10月至2017年5月东莞市人民医院收治的180例下肢DVT患者,其中120例接受血管腔内治疗联合导管接触性溶栓治疗（介入组）;60例在足量抗凝治疗基础上,经患肢足背静脉局部溶栓（对照组）;所有患者出院后抗凝治疗2年;介入组26例患者停止抗凝后血栓复发,再次接受血管腔内治疗,其后终身抗凝治疗;比较两组的治疗效果、髂静脉通畅率及血栓后综合征（PTS）发生率。 结果：介入组的有效率明显优于对照组（100% vs. 86.7%）,差异有统计学意义（Z=113.679,P<0.05）;介入组治疗1、2、5、10年后,患侧髂静脉血管通畅率分别为89.2%、95%、84.6%、100%,远高于对照组的8.3%、5%、0%、0%;介入组PTS发生率（13.3%）明显低于单纯抗凝治疗组（46.7%）,差异有统计学意义。 结论：血管腔内治疗能有效提高DVT患者的治疗效果,降低PTS的发生率,血管腔内治疗急性DVT安全、有效。     

探讨经导管高压团注尿激酶治疗急性下肢深静脉栓塞疗效观察

目的比较高压团注尿激酶和常规压力置管溶栓治疗急性下肢深静脉血栓的临床疗效。方法回顾性分析2017年5月~2018年12月我院收治的37例急性下肢深静脉血栓形成患者的临床资料,依据治疗方式不同分为观察组(n=20)和对照组(n=17),在每天使用同等剂量尿激酶的情况下,观察组给予经导管用高压注射器团注尿激酶溶栓治疗,对照组给予常规微量泵经导管接触溶栓治疗。2组均按体重给予基础抗凝治疗,术后常规抗凝6个月。比较2组患者的溶栓治疗效果,治疗前后患肢大腿、小腿的周径差值,溶栓并发症的发生率,3、6个月后深静脉通畅状况、复发率。结果在使用相同剂量尿激酶情况下,2组患者经治疗后,临床症状均明显改善,观察组部分通畅14例,完全通畅5例;对照组部分通畅9例,完全通畅3例。与对照组比较,观察组患者的溶栓时间短、并发症的发生率低,差异有统计学意义(P<0.05)。随访发现深静脉瓣膜功能保存率无差异。结论对于下肢深静脉血栓形成的治疗,经导管高压团注溶栓比常规导管接触溶栓的效果好,可以缩短治疗时间,减少溶栓并发症的发生率,瓣膜功能保存率无差异,总的治疗费用较低。     

下腔静脉滤器置入术预防致死性肺动脉栓塞：附三例分析

下腔静脉滤器置入术预防下肢深静脉血栓形成后血栓脱落，发生致死性肺动脉栓塞，在欧美等国已得到广泛应用。作者总结了３例下肢深静脉血栓形成后抗凝和／或溶栓治疗无效的病例。男２例，女１例。采用钛质Ｇｒｅｅｎｆｉｅｌｄ下腔静脉滤器，以１２Ｆ直径的输送鞘管置入，滤器置下肾静脉下方的下腔静脉内。２例左髂股静脉血栓形成，经右股静脉置入，１例右侧病变，经左侧进路。随诊１￣１２个月，观察到１例滤器向头端移位０．７ｃｍ     

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.     

Determinants of Early and Long-term Efficacy of Catheter-directed Thrombolysis in Proximal Deep Vein Thrombosis

PurposeCatheter-directed thrombolysis (CDT) for proximal deep vein thrombosis (DVT) effectively enhances clot removal and recently has been shown to reduce the development of postthrombotic syndrome (PTS). This study was performed to identify potential markers for early and long-term efficacy of CDT, adverse events, and their interrelationship.Materials and MethodsPatients aged 18–75 years (mean, 54 y; 33 women) with first-time proximal DVT and symptoms up to 21 days were included in subanalyses in an open, multicenter, randomized, controlled trial. Early efficacy was assessed with a thrombus score based on daily venography. Six-month and 2-year follow-up included iliofemoral patency assessed with duplex ultrasound and air plethysmography, and PTS was assessed with the Villalta scale.ResultsA mean clot resolution of 82%±25 was achieved in 92 patients. Successful lysis (ie,≥50%) was obtained in 83 patients. Early efficacy was equal for femoral and iliofemoral thrombus and not related to thrombus load before CDT, symptom duration, or predisposing risk factors. Lower thrombus score at completion of CDT was associated with increased patency at 24 months (P = .040), and increased patency after 6 and 24 months was correlated with reduced development of PTS after 24 months (P<.001). Bleeding complications were mainly related to the puncture site, and popliteal vein access led to fewer bleeding incidents.ConclusionsComp, this is a Clinical Study article, so, as noted on the TOC, the Conclusions section of the abstract gets listed on the TOC. CDT via popliteal access was safe, effectively removed clots, and restored iliofemoral patency. Preprocedure evaluation did not identify patients who did not benefit from treatment. Early efficacy and follow-up patency are of importance to reduce the risk for PTS.     

Correlation between Post-Procedure Residual Thrombus and Clinical Outcome in Deep Vein Thrombosis Patients Receiving Pharmacomechanical Thrombolysis in a Multicenter Randomized Trial

PurposeTo evaluate relationships between immediate venographic results and clinical outcomes of pharmacomechanical catheter-directed thrombolysis (PCDT).Materials and MethodsVenograms from 317 patients with acute proximal deep vein thrombosis (DVT) who received PCDT in a multicenter randomized trial were reviewed. Quantitative thrombus resolution was assessed by independent readers using a modified Marder scale. The physician operators recorded their visual assessments of thrombus regression and venous flow. These immediate post-procedure results were correlated with patient outcomes at 1, 12, and 24 months.ResultsPCDT produced substantial thrombus removal (P < .001 for pre-PCDT vs. post-PCDT thrombus scores in all segments). At procedure end, spontaneous venous flow was present in 99% of iliofemoral venous segments and in 89% of femoral–popliteal venous segments. For the overall proximal DVT population, and for the femoral–popliteal DVT subgroup, post-PCDT thrombus volume did not correlate with 1-month or 24-month outcomes. For the iliofemoral DVT subgroup, over 1 and 24 months, symptom severity scores were higher (worse), and venous disease-specific quality of life (QOL) scores were lower (worse) in patients with greater post-PCDT thrombus volume, with the difference reaching statistical significance for the 24-month Villalta post-thrombotic syndrome (PTS) severity score (P = .0098). Post-PCDT thrombus volume did not correlate with 12-month valvular reflux.ConclusionsPCDT successfully removes thrombus in acute proximal DVT. However, the residual thrombus burden at procedure end does not correlate with the occurrence of PTS during the subsequent 24 months. In iliofemoral DVT, lower residual thrombus burden correlates with reduced PTS severity and possibly also with improved venous QOL and fewer early symptoms.     

Deep venous thrombosis associated with protein C and/or S deficiency: management with catheter-directed thrombolysis

We performed this study to evaluate the efficacy of catheter-directed thrombolysis with urokinase in treating acute symptomatic iliofemoral deep venous thrombosis associated with protein C and/or S deficiency. A total of 42 consecutive patients with deep venous thrombosis were seen between September 2000 and August 2002. Of these, catheter-directed thrombolysis via the popliteal vein was performed in 5 patients (11.9%) with acute iliofemoral deep venous thrombosis associated with protein C and/or S deficiency. Average duration of symptoms was 4.2 days (range, 1-7 days). The average urokinase dose was 2.7 million IU (range, 0.6 million to 7.0 million IU) infused over an average of 33.1 h (range, 16-67 h). Lysis was complete in all five treated cases. Two cases had underlying iliac venous stenoses (>50%) that were treated with angioplasty and stent placement. In one patient in whom recanalization of a right iliac vein occlusion was successful, thrombosis occurred in the treated vein within 3 weeks of intervention despite full anticoagulation therapy, and further intervention was required. There were no complications or clinically detectable pulmonary emboli. The technical and clinical success rates were 100%. This initial experience suggests that catheter-directed thrombolysis for treatment of acute symptomatic iliofemoral deep venous thrombosis associated with protein C and/or S deficiency is safe and effective.     

深静脉血栓的血管内溶栓治疗

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。     

经颈静脉导管血管内溶栓联合足背静脉溶栓治疗下肢深静脉血栓

目的 探讨经颈静脉途径血管内溶栓联合足背静脉溶栓,治疗下肢深静脉血栓的可行性与疗效.方法 18例下肢深静脉血栓患者(治疗组)采用经颈静脉穿刺后,置管造影并植入滤器,留置导管持续血管内溶栓同时联合足背静脉溶栓;而同期有16例患者(对照组)仅行足背静脉溶栓.结果 治疗组溶栓时间为(6.6±2.3)d,对照组为(8.2 ±1.4)d;所用尿激酶总量治疗组为(552±224)万u,对照组为(700±166)万u.联合溶栓能显著减少溶栓时间与尿激酶用量(P＜0.05).治疗组溶栓前后大、小腿周径分别减小(4.6 ±2.1)cm、(4.0±2.1)cm,对照组分别为(3.2±1.7)cm、(2.7±1.5)cm,两组间差异有统计学意义(P＜0.05).治疗组完全溶通率为66.7%.对照组完全溶通率为31.3%,两组间差异有统计学意义(P＜0.05).治疗组4例患者在血栓完全溶通后从原穿刺处将滤器取出.结论 经颈静脉途径导管内溶栓联合足背静脉溶柃治疗下肢深静脉血栓安全、效果好,完全溶通后可从原穿刺处回收滤器.     

Clinical Outcomes of a Pharmacomechanical Catheter-Directed Venous Thrombolysis Strategy that Included Rheolytic Thrombectomy in a Multicenter Randomized Trial

PurposeTo describe the clinical outcomes of a pharmacomechanical catheter-directed venous thrombolysis (PCDT) strategy that included AngioJet rheolytic thrombectomy.MethodsIn the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis multicenter randomized trial, physicians at 33 sites designated AngioJet as their preferred device for PCDT. In these sites, 364 patients with acute proximal lower-extremity deep vein thrombosis (DVT) were randomized to a strategy of PCDT that incorporated either AngioJet along with anticoagulation or anticoagulation alone. Relief from presenting DVT symptoms was evaluated over 30 days of follow-up. Postthrombotic syndrome (PTS), quality of life (QOL), recurrent venous thromboembolism (VTE), and safety were evaluated over 24 months of follow-up.ResultsWithin 30 days, AngioJet-PCDT led to a greater improvement in leg swelling (mean difference calf circumference 0.55 cm, P = .009), venous QOL (mean difference 6.5 Venous Insufficiency Epidemiologic and Economic Study [VEINES]-QOL points, P = .0073), and venous symptoms (mean difference 5.6 VEINES-symptoms points, P = .0134) than control, with differences most apparent in iliofemoral DVT. AngioJet-PCDT reduced PTS at 6 months (24% with AngioJet-PCDT vs 40% with control, P = .003) but did not influence PTS or QOL between 12 and 24 months. Major bleeding, pulmonary embolism, renal failure, and bradycardia were infrequent with AngioJet-PCDT (<2% each), but 24-month VTE recurrence may have been more frequent (13.9% with AngioJet-PCDT vs 6.8% with control, P = .03)ConclusionsIn patients with acute proximal DVT, a treatment strategy that included first-line AngioJet-PCDT was reasonably safe and led to an improved symptom status and venous QOL at 1 month and reduced PTS at 6 months compared with anticoagulation alone. However, AngioJet-PCDT did not influence PTS or the QOL beyond 6 months and may have increased recurrent VTE.