Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis. A randomised clinical trial.

OBJECTIVE: catheter directed thrombolysis has been advocated for complete and rapid dissolution of iliofemoral deep venous thrombosis (DVT). The aim of our study is to compare, in a randomised trial, local thrombolysis and anticoagulation with anticoagulation alone in patients with iliofemoral DVT. METHODS: a consecutive series of 35 eligible patients, were randomised to either catheter directed thrombolysis followed by anticoagulation or to anticoagulation alone. Clot lysis and deep venous reflux were assessed with ultrasound duplex and plethysmography after 6 months. RESULTS: complete data were available in the 18 and 17 patients randomised to thrombolysis and anticoagulation, respectively. At 6 months, patency rate was better in cases treated with thrombolysis [13/18 (72%) vs 2/17 (12%), p < 0.001]. Venous reflux was higher in-patients treated with anticoagulant [7 patients (41%) vs 2 (11%), p = 0.04]. CONCLUSION: in the short-term patients treated with catheter directed thrombolysis obtained better patency and competence than those treated with standard anticoagulation.     

Treatment of acute iliofemoral deep venous thrombosis: a strategy of thrombus removal.

Patients with acute iliofemoral deep vein thrombosis (DVT) suffer the most severe postthrombotic sequelae. The majority of physicians treat all patients with acute DVT with anticoagulation alone, despite evidence that postthrombotic chronic venous insufficiency, leg ulceration, and venous claudication are common in patients treated only with anticoagulation. The body of evidence to date in patients with iliofemoral DVT suggests that a strategy of thrombus removal offers these patients the best long-term outcome. Unfortunately, currently published guidelines use outdated experiences to recommend against the use of techniques designed to remove thrombus, ignoring recent clinical studies showing significant benefit in patients who have thrombus eliminated. Contemporary venous thrombectomy, intrathrombus catheter-directed thrombolysis, and pharmacomechanical thrombolysis are all options that can be offered to successfully remove venous thrombus with increasing safety. The authors review evidence supporting the rationale for thrombus removal and discuss the most effective approaches for treating patients with acute iliofemoral DVT.     

Iliofemoral venous thrombosis

Iliofemoral deep vein thrombosis (DVT) is associated with serious short- and long-term physical, social, and economic sequelae for patients. Most physicians treat patients with acute iliofemoral DVT in the same manner as they treat all acute DVT patients: with anticoagulation alone. Yet a growing body of evidence suggests that, in this subset of DVT patients, a treatment strategy that includes thrombus removal plus optimal anticoagulation significantly improves outcomes. This article reviews the evidence supporting this strategy and discusses current and promising techniques of thrombus removal, including contemporary venous thrombectomy, intrathrombus catheter-directed thrombolysis, and pharmacomechanical thrombolysis.     

Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life

PURPOSE: Treatment designed to eliminate thrombus in patients with iliofemoral deep venous thrombosis (DVT) is theoretically attractive; however, its benefits, compared with those of anticoagulation, have not been definitively demonstrated. Although not previously analyzed, an effective measure of treatment success is likely to be the assessment of health-related quality of life (HRQOL). This study evaluated whether catheter-directed thrombolysis for iliofemoral DVT is associated with improved HRQOL, compared with standard anticoagulation, and whether HRQOL outcome in the thrombolysis group is related to lytic success. METHODS: An 80-item self-administered HRQOL questionnaire was developed. It contained the Health Utilities Index, Short Form-12, and disease-targeted scales, including health distress, stigma, health interference, physical functioning, and symptoms (eg, leg swelling, pain, ulcers). The HRQOL questionnaire was confirmed to be reliable and valid by means of psychometric testing. Questionnaires were administered to 98 retrospectively identified patients who had had iliofemoral DVT treated at least 6 months earlier. Sixty-eight patients who were identified through a DVT registry were treated with catheter-directed thrombolysis with urokinase (UK), and 30 patients who were identified by means of a medical record review were treated with anticoagulation alone. The treatment decision was made by the attending physician, and all patients were candidates for both thrombolysis and anticoagulation. RESULTS: Most patients were women (61%), white (95%), married (65%), and had a mean interval since initial DVT of 16 months. The group treated with UK was younger (53 +/- 17 years) than the group treated with heparin (61 +/- 6 years; P =.039). After treatment, patients treated with UK reported better overall physical functioning (P =.046), less stigma (P =.033), less health distress (P =.022), and fewer post-thrombotic symptoms (P =. 006), compared with the patients treated with anticoagulation alone. Within the UK group, phlebographically successful lysis correlated with improved HRQOL (P =.038). Patients classified as lytic failures had similar outcomes to patients treated with heparin. CONCLUSION: Patients with iliofemoral DVT treated with catheter-directed thrombolysis have better functioning and well-being, compared with patients treated with anticoagulation alone. Successful lysis was directly correlated with improved HRQOL, with patients who were classified as lytic failures having similar outcomes to patients treated with heparin. These data support the need for a future randomized trial, which should include an HRQOL measure as part of the outcome analysis.     

高频超声引导下经腘静脉穿刺置管溶栓治疗下肢深静脉血栓

目的探讨经腘静脉穿刺置管直接溶栓治疗下肢深静脉血栓(DVT)的应用价值。方法收集经CDFI或下肢深静脉造影确诊为DVT的36例患者。对观察组患者行超声引导下患侧腘静脉穿刺,置入溶栓导管,经导管持续灌注尿激酶溶栓;对照组采用经外周静脉滴注尿激酶,比较两组的治疗效果。结果观察组(16例)患者自治疗后第2天患肢肿胀开始减退,第4～6天时肿胀明显减退,治愈3例,显效11例,有效2例,总体有效率为100%(16/16);对照组(20例)自第2～4天起患肢肿胀开始减退,第7～9天明显减退,显效8例,有效6例,无效6例,总体有效率为70.00%(14/20);两组治疗效果的差异有统计学意义(Z=3.270,P=0.002)。溶栓治疗前后观察组肢体肿胀缓解程度较对照组明显,患肢大腿及小腿周径的差异均有统计学意义(P均<0.01)。结论于高频超声引导下经腘静脉穿刺置管直接溶栓治疗DVT安全、微创、疗效确切,且并发症少。     

DSA引导下胫后/胫前静脉穿刺置管碎栓/溶栓治疗急性下肢深静脉血栓形成

目的:初步探讨DSA引导下行胫后/胫前静脉穿刺置管碎栓/溶栓治疗急性下肢深静脉血栓形成(DVT)的疗效。方法:对2012年8月—2016年11月收治的87例混合型及中央型DVT患者行DSA引导下经胫后/胫前静脉穿刺置管碎栓/溶栓治疗,以术前、术后肢体的周径差以及溶栓后造影深静脉通畅情况评估疗效。结果:87例患者80例穿刺成功(91.9%),其中胫后静脉穿刺成功68例,胫前静脉穿刺成功12例,未穿刺成功7例行胫后静脉切开置管。置管成功后均行碎栓术,并行留置导管溶栓。与溶栓前比较,溶栓后患者小腿周径差明显减小[(4.28±1.02)cmvs.(1.06±0.42cm)],静脉通畅度评分明显降低[(10.25±1.84)vs.1.92±0.5)],差异均有统计学意义(均P0.05)。结论:DSA引导下经胫后/胫前静脉穿刺置管碎栓/溶栓治疗下肢DVT是一种简便、有效、疗效确切的方法。     

Safety of catheter-directed thrombolysis for deep venous thrombosis in cancer patients

BACKGROUND: The current study was conducted to demonstrate that catheter-directed thrombolysis for upper and lower extremity deep vein thrombosis is equally safe in patients with and without cancer. METHODS: A retrospective cohort of consecutive patients with acute iliofemoral or brachiosubclavian deep vein thrombosis treated with catheter-directed thrombolysis was identified. Demographic characteristics and clinical outcomes were compared between patients with cancer and without cancer. RESULTS: Catheter-directed thrombolysis was used to treat 202 limbs in 178 patients (75 limbs in 61 cancer patients and 127 limbs in 117 patients without cancer). The mean treatment duration for patients with cancer (29.7 +/- 21.2 hours) and without cancer (28.8 +/- 22.2 hours) was similar (P = .7774). Catheter-directed thrombolysis achieved grade III clot lysis in a similar proportion of cancer patients (50 of 75 limbs, 66.7%) and patients without cancer (82 of 127 limbs, 64.6%; P = .7619). Grade II clot lysis also was achieved in equal numbers of patients with (20 of 75 limbs, 26.7%) and without cancer (34 of 127 limbs, 26.8%; P = .9872). Three cancer patients (4.9%) and four noncancer patients (3.4%) experienced major bleeding during catheter-directed thrombolysis (P = .6924). Pulmonary embolism occurred in 1.6% (1 of 61) of cancer patients and in 1.7% (2 of 117) of patients without cancer (P = .9999) during catheter-directed thrombolysis. Patients aged > or =70 years had an increased risk of major bleeding. CONCLUSION: Percutaneous catheter-directed thrombolysis is equally safe for patients with and without cancer who have acute symptomatic deep vein thrombosis.     

Catheter-directed thrombolysis following vena cava filtration for severe deep venous thrombosis

Massive deep venous thrombosis with marked venous outflow obstruction can result in limb loss or end-organ injury. Systemically administered drugs may not reach thrombi in therapeutic concentrations and surgical and thrombolytic strategies carry a small but real risk of pulmonary embolus—similar to the risks with anticoagulation alone. We therefore developed a strategy in which catheter-directed thrombolysis was used to deliver high concentrations of a plasminogen activator directly to the thrombus combined with placement of a downstream Greenfield filter to protect patients from pulmonary embolus. From 1984 to 1993 six patients were treated with this regimen. All had severe symptoms of less than 4 days' duration. On radiologic evaluation four patients had large iliofemoral and/or inferior vena cava thrombosis, one had subclavian/innominate vein thrombosis, and one had transplant renal vein/iliofemoral/inferior vena cava thrombosis. A Greenfield filter was first placed downstream prior to imbedding an infusion catheter in the greatest mass of thrombus for subsequent infusion of urokinase (n=4) or streptokinase (n=2). In four patients the catheter traversed the Greenfield filter. All patients were given bolus lytic therapy followed by maintenance infusions ranging in duration from 24 hours to 12 days. Five patients remained on heparin simultaneously. Clot lysis was achieved in all patients with hemodynamic, symptomatic, and arteriographic improvement. There were no deaths, pulmonary emboli, or complications of filter placement. One patient had minor bleeding at the puncture site and another had catheter-related infection. At follow-up ranging from 8 months to 9 years all patients are asymptomatic with patent venous systems confirmed by duplex ultrasound imaging. Thus catheter-directed thrombolysis combined with vena cava filtration offers a safe and effective alternative to simple anticoagulation, surgery, or systemic thrombolysis. This approach may warrant more frequent use in patients with severe and disabling thrombosis of major deep veins.     

Catheter directed thrombolysis for treatment of ilio-femoral deep venous thrombosis is durable, preserves venous valve function and may prevent chronic venous insufficiency.

OBJECTIVES: To investigate the results of catheter directed thrombolysis offered to patients with acute femoro-iliac deep venous thrombosis (DVT). DESIGN: Retrospective analysis of all patients treated with this modality at Gentofte Hospital until December 2003. MATERIAL: Forty-five consecutive patients treated between June 1999 and December 2003 with a median age of 31 years. All patients had femoro-iliac DVT with an average anamnesis of 6 days. METHODS: All patients were treated by catheter directed infusion of alteplase into the popliteal vein. After thrombolysis residual venous stenoses were treated by percutaneous balloon angioplasty (PTA) and stenting. Patients were followed with color-duplex scanning for assessment of venous patency and reflux. RESULTS: Forty-two of 45 (93%) of cases were treated successfully with reopening of the thrombosed vein segments. In 30 of 45 cases a residual stenosis was treated by PTA and stenting. Only one serious complication was observed: Compartment syndrome of the forearm where arterial punctures had been taken. After an average of 24 months follow-up were no cases of re-thrombosis among the 42 patients discharged with open veins. Only two of 41 with presumed normal venous valve function prior to DVT developed reflux during follow-up. CONCLUSION: In this selected patient group, catheter directed thrombolysis seems effective in treating acute DVT, it appears durable and preserves venous valve function in the majority. The method needs to be tested in a randomised controlled trial.     

Radiation-associated venous stenosis: endovascular treatment options

We report a case of radiation-induced venous stenosis after pelvic irradiation to treat Paget's disease of the scrotum. During therapeutic anticoagulation, significant left lower extremity swelling developed due to an iliofemoral deep venous thrombosis (DVT). After percutaneous thrombectomy and thrombolysis, a high-grade stenosis was uncovered in the left external iliac vein, which was treated with an endoluminal stent. However, ipsilateral DVT recurred 2 months later despite continued anticoagulation therapy. Repeat treatment was successful. Pelvic radiation is a potential cause of iliac vein stenosis. Pharmacomechanical thrombectomy may have a useful role in management of complex iliofemoral DVT.     

Deep venous thrombosis and superficial venous reflux

OBJECTIVE: Although superficial venous reflux is an important determinant of post-thrombotic skin changes, the origin of this reflux is unknown. The purpose of this study was to evaluate the frequency and etiologic mechanisms of superficial venous reflux after acute deep venous thrombosis (DVT). METHODS: Patients with a documented acute lower extremity DVT were asked to return for serial venous duplex ultrasound examinations at 1 day, 1 week, 1 month, every 3 months for the first year, and every year thereafter. Reflux in the greater saphenous vein (GSV) and lesser saphenous vein (LSV) was assessed by standing distal pneumatic cuff deflation. RESULTS: Sixty-six patients with a DVT in 69 lower extremities were followed up for a mean of 48 (SD +/- 32) months. Initial thrombosis of the GSV was noted in 15 limbs (21.7%). At 8 years, the cumulative incidence of GSV reflux was 77.1% (SE +/- 0.11) in DVT limbs with GSV involvement, 28.9% (+/- 0.09%) in DVT limbs without GSV thrombosis, and 14.8% (+/- 0.05) in uninvolved contralateral limbs (P <.0001). For LSV reflux, the cumulative incidence in DVT limbs was 23.1% (+/- 0.06%) in comparison with 10% (+/- 0.06%) in uninvolved limbs (P =.06). In comparison with uninvolved contralateral limbs, the relative risk of GSV reflux for DVT limbs with and without GSV thrombosis was 8.7 (P <.001) and 1.4 (P =.5), respectively. The relative risk of LSV reflux in thrombosed extremities compared with uninvolved extremities was 3.2 (P =.07). Despite these observations, the fraction of observed GSV reflux that could be attributable to superficial thrombosis was only 49%. CONCLUSIONS: Superficial venous thrombosis frequently accompanies DVT and is associated with development of superficial reflux in most limbs. However, a substantial proportion of observed reflux is not directly associated with thrombosis and develops at a rate equivalent to that in uninvolved limbs.     

腔内综合治疗髂股静脉血栓形成

目的:探讨腔内治疗急性髂股静脉血栓形成的临床疗效。方法:回顾性分析2013年1月―2015年1月64例行腔内综合治疗的急性髂股静脉血栓形成患者临床资料。结果:患者经下腔静脉滤器保护下置管溶栓术治疗后,新鲜血栓均得到有效溶解,无严重溶栓并发症发生;13例(13/64)患者发现髂静脉狭窄严重,下肢肿胀缓解不明显,同期行球囊扩张,其中5例(5/64)二期造影发现侧支血管代偿不佳、髂静脉狭窄50%,行二期支架植入。经腔内综合治疗,患者的双下肢膝上15 cm周径差较术前明显缩小(3.87 cm vs.7.56 cm,P0.05);随访期间无再发下肢肿胀、髂股静脉狭窄及支架内血栓形成,无下肢色素沉着及溃疡形成,无肺动脉栓塞及死亡病例。结论:腔内综合治疗急性髂股静脉血栓形成安全、有效,对清除血栓、解除狭窄实现管腔再通效果良好。     

超声引导置管溶栓治疗下肢深静脉血栓

目的探讨超声引导置管溶栓治疗下肢深静脉血栓(DVT)的临床应用价值。方法收集55例下肢DVT患者,分为置管溶栓组(n=35)和对照组(n=20)。治疗前对所有患者均行超声检查以了解DVT情况。置管溶栓组:下腔静脉滤器置入术后,在超声引导下行患肢静脉置管,用微量泵持续向导管内给予尿激酶和肝素;对照组经静脉注射溶栓尿激酶和肝素进行全身治疗。治疗后所有患者均复查超声,观察疗效并进行比较。结果置管溶栓组所有患者置管成功,其中26例治愈,6例有效,3例无效,总有效率为91.43%(32/35)。对照组5例治愈,8例有效,7例无效,总有效率为65.00%(13/20)。两组疗效差异有统计学意义(χ2=12.99,P0.05)。结论超声引导置管溶栓治疗下肢DVT特异性高、见效快、疗程短,是治疗下肢DVT的有效方法。     

Treatment of May-Thurner syndrome with catheter-directed thrombolysis and stent placement, complicated by heparin-induced thrombocytopenia.

May-Thurner syndrome is an uncommon process in which the right common iliac artery compresses the left common iliac vein, resulting in left iliofemoral deep vein thrombosis and severe leg edema. We report the case of a 41-year-old female who presented with severe left leg edema present for 1 day. One week earlier she had experienced acute shortness of breath and pleuritic chest pain. Duplex ultrasound revealed a left iliofemoral deep vein thrombosis. A computed tomography (CT) scan performed for abdominal pain revealed thrombosis of the entire left common and external iliac veins. A ventilation-perfusion scan diagnosed a pulmonary embolism. The patient was treated with systemic intravenous heparin and catheter-directed thrombolysis of the iliofemoral deep vein thrombosis. Complete thrombolysis and iliofemoral vein patency was achieved over 5 days. A persistent stenosis in the left common iliac vein consistent with May-Thurner syndrome was alleviated with percutaneous balloon angioplasty and placement of a Wallstent. Heparin therapy was terminated at the time of stenting because of suspected heparin-induced thrombocytopenia. The patient was started on a continuous infusion of 10% dextran 40, and warfarin therapy was initiated. Heparin-induced antibodies were confirmed by a C-14 serotonin release assay. The endovascular reconstruction remains patent 4 months later. Heparin-induced thrombocytopenia complicating endovascular reconstruction of the iliofemoral venous system in a patient with May-Thurner Syndrome is an uncommon occurrence. This case and a review of the literature are discussed.     

合并Cockett综合征的急性下肢深静脉血栓形成患者髂静脉扩张成形时机对导管直接溶栓持续时间的影响

目的探讨合并Cockett综合征的急性下肢深静脉血栓形成（deep vein thrombosis,DVT）患者髂静脉扩张成形时机对导管直接溶栓持续时间的影响。方法回顾性分析38例急性DVT合并Cockett综合征患者的临床资料,根据髂静脉扩张成形和导管直接溶栓的先后顺序,分为导管直接溶栓前扩张髂静脉狭窄（n=14,A组）与导管直接溶栓过程中或溶栓后扩张髂静脉狭窄（n=24,B组）2组,比较溶栓时间、溶栓效果以及扩张局部出血情况。结果A组溶栓时间（25．79±18．23）h,B组（46．83±23．36）h,差异有显著性（t=-2．891,P=0．006）,2组溶栓效果差异无显著性（P〉0．05）。结论介入治疗急性下肢深静脉血栓形成合并Cockett综合征时,髂静脉扩张成形在导管直接溶栓之前实施能够显著缩短溶栓时间,且不增加出血风险。     

A 16-year haemodynamic follow-up of women with pregnancy-related medically treated iliofemoral deep venous thrombosis.

OBJECTIVES: to evaluate clinical and functional long-term outcomes following pregnancy-related medically treated iliofemoral deep venous thrombosis (DVT). DESIGN: retrospective follow-up of patients identified through a registry search. MATERIAL AND METHODS: twenty-five women underwent clinical examination, colour duplex ultrasound and computerised strain-gauge plethysmography on two occasions a mean of nine and 16 years after DVT. RESULTS: 40% of the patients were completely asymptomatic and 52% had no clinical signs of venous disease after a mean follow-up of 16 years. The clinical signs were in general mild, and none of the 25 patients had skin changes or ulcers. Deep venous reflux was found in 36% of the patients; the same percentage at nine- and 16-years follow-up, and 24% had normal ultrasonographic appearance of all deep veins. None of the patients had plethysmographic evidence of outflow obstruction. There was a significant relationship between measures of venous reflux and the presence of leg swelling, but there was no clear relation between functional abnormalities and the extent of the initial DVT. CONCLUSION: even after 16 years there are relatively mild symptoms and signs of venous disease in women with medically treated pregnancy-related iliofemoral DVT. Our results do not support earlier stated opinions that these patients represent a particular risk group for developing post-thrombotic syndrome.     

Catheter-directed thrombolysis and/or thrombectomy with selective endovascular stenting as alternatives to systemic anticoagulation for treatment of acute deep vein thrombosis

PURPOSE: To evaluate thrombolysis and/or thrombectomy and selective endovascular stent placement in treating acute deep vein thrombosis (DVT). METHODS: During a 5-year period, 28 patients were treated with catheter-directed thrombolytics and/or thrombectomy with endovascular stent placement. Seventy-two percent (n = 20) of patients had symptoms for less < or = 14 days; 14% (n = 4) had symptoms for > 14 days. Fourteen percent (n = 4) had recurrent symptoms; 43% (n = 12) had ileofemoral DVT, and 57% (n = 16) had common femoral, superficial femoral, and/or popliteal DVT; and 11% (n = 3) had thrombus extending into the inferior vena cava. RESULTS: Eighteen percent (n = 5) of patients had complete thrombolysis of the thrombus; 72% (n = 20) had partial thrombolysis. Twenty-two stents were also placed in 12 patients. Average follow-up was 15.5 months; 80% had long-term patency. CONCLUSIONS: Catheter-directed thrombolysis and/or thrombectomy and selective stent placement are effective alternatives to systemic anticoagulation in the treatment of DVT. More studies are needed to determine specific indications and to validate long-term efficacy.     

手术取栓联合腔内介入治疗急性深静脉血栓的临床分析

目的 总结手术取栓联合腔内介入治疗急性髂股深静脉血栓(DVT)的临床经验.方法 2008年10月至2010年12月,15例急性DVT患者接受手术取栓联合同侧髂静脉腔内支架植入术.男性6例,女性9例;年龄36～71岁,平均57.4岁.DVT位于左股、髂及下腔静脉内2例,双侧髂静脉1例,其余12例均在左髂股静脉.所有患者表现患肢明显肿胀,其中12例伴有患肢疼痛.DVT发病时间平均为3.3 d.诱发DVT的原因包括外科手术6例,DVT复发2例,其余7例病因不清.并发症包括消化道出血1例,胃溃疡1例,高血压3例,脑梗死1例.取栓之前均先经右股静脉穿刺植入下腔静脉滤器(包括1例双髂静脉血栓患者),取栓之后术中造影均发现髂静脉受压致重度狭窄或完全闭塞,均先行球囊血管成形后植入自膨式支架.结果 术中造影证实髂静脉压迫综合征12例,取栓后残留狭窄3例.共植入18枚自膨式支架,手术成功率15/15,30 d病死率为0;1例术后伤口出现血肿,保守治疗后痊愈.12例获得随访,随访时间为2～26个月,平均13.3个月.所有患者疼痛消失,仅2例表现为活动后患肢轻度肿胀.所有患者均未出现血栓复发.结论 手术取栓联合腔内介入治疗急性DVT安全有效,早期临床结果满意,并发症发生率低.

Abstract：

Objective To evaluate the clinical outcome of surgical venous thrombectomy and simultaneous stenting in patients with acute, symptomatic iliofemoral deep venous thrombosis ( DVT) .Methods From October 2008 to December 2010, a total of 15 patients with acute symptomatic DVT underwent combined surgical venous thrombectomy and endovascular stenting in ipsilateral iliac vein. There were 6 male and 9 female patients, with a mean age of 57. 4 years ( ranging from 36 to 71 years) . All patients underwent Duplex ultrasonography for diagnosis of DVT. The location of thrombosis was femoroiliocaval vein in 2 cases, bilateral iliac vein in 1 case and left iliofemoral vein in 12 cases. All patients had leg swelling and 12 cases had severe leg pain. The mean time of symptomatic DVT occurring at operation was 3. 3 d. The factors related to DVT were operation in 6 cases, DVT reoccur in 2 cases. Coexist diseases were digestive tract bleeding in 1 case, gastric ulcer in 1 case, hypertension in 3 cases and 1 case had cerebral infarction. The inferior vena cava filter was inserted before thrombectomy, iliac vein compression and residual stensosis were treated with a self-expandable stent after thrombectomy. Results Intraoperative venography showed severe venous stenosis in all patients including 80% of iliac vein compression syndrome, 18 self-expandable stents were inserted successfully, the procedural successful rate was 100% , the 30-day mortality rate was 0. One case was suffered from hematoma at incision after operation.3 patients were lost during follow-up. Median follow-up was 10. 3 months ( ranging from 2 to 26 months). There was no case of re-thrombosis. Leg pain was disappeared in all cases and only 2 patients showed slight leg swelling after excise. Conclusion Combined surgical thrombectomy and endovascular treatment for patients with acute symptomatic iliofemoral venous thrombosis is an effective and safe technique with low morbidity and good clinical results.     

手术取栓联合腔内介入治疗急性深静脉血栓的临床分析

目的 总结手术取栓联合腔内介入治疗急性髂股深静脉血栓(DVT)的临床经验.方法 2008年10月至2010年12月,15例急性DVT患者接受手术取栓联合同侧髂静脉腔内支架植入术.男性6例,女性9例;年龄36～71岁,平均57.4岁.DVT位于左股、髂及下腔静脉内2例,双侧髂静脉1例,其余12例均在左髂股静脉.所有患者表现患肢明显肿胀,其中12例伴有患肢疼痛.DVT发病时间平均为3.3 d.诱发DVT的原因包括外科手术6例,DVT复发2例,其余7例病因不清.并发症包括消化道出血1例,胃溃疡1例,高血压3例,脑梗死1例.取栓之前均先经右股静脉穿刺植入下腔静脉滤器(包括1例双髂静脉血栓患者),取栓之后术中造影均发现髂静脉受压致重度狭窄或完全闭塞,均先行球囊血管成形后植入自膨式支架.结果 术中造影证实髂静脉压迫综合征12例,取栓后残留狭窄3例.共植入18枚自膨式支架,手术成功率15/15,30 d病死率为0;1例术后伤口出现血肿,保守治疗后痊愈.12例获得随访,随访时间为2～26个月,平均13.3个月.所有患者疼痛消失,仅2例表现为活动后患肢轻度肿胀.所有患者均未出现血栓复发.结论 手术取栓联合腔内介入治疗急性DVT安全有效,早期临床结果满意,并发症发生率低.     

手术取栓联合腔内介入治疗急性深静脉血栓的临床分析

目的 总结手术取栓联合腔内介入治疗急性髂股深静脉血栓(DVT)的临床经验.方法 2008年10月至2010年12月,15例急性DVT患者接受手术取栓联合同侧髂静脉腔内支架植入术.男性6例,女性9例;年龄36～71岁,平均57.4岁.DVT位于左股、髂及下腔静脉内2例,双侧髂静脉1例,其余12例均在左髂股静脉.所有患者表现患肢明显肿胀,其中12例伴有患肢疼痛.DVT发病时间平均为3.3 d.诱发DVT的原因包括外科手术6例,DVT复发2例,其余7例病因不清.并发症包括消化道出血1例,胃溃疡1例,高血压3例,脑梗死1例.取栓之前均先经右股静脉穿刺植入下腔静脉滤器(包括1例双髂静脉血栓患者),取栓之后术中造影均发现髂静脉受压致重度狭窄或完全闭塞,均先行球囊血管成形后植入自膨式支架.结果 术中造影证实髂静脉压迫综合征12例,取栓后残留狭窄3例.共植入18枚自膨式支架,手术成功率15/15,30 d病死率为0;1例术后伤口出现血肿,保守治疗后痊愈.12例获得随访,随访时间为2～26个月,平均13.3个月.所有患者疼痛消失,仅2例表现为活动后患肢轻度肿胀.所有患者均未出现血栓复发.结论 手术取栓联合腔内介入治疗急性DVT安全有效,早期临床结果满意,并发症发生率低.