永久性和临时性腔静脉过滤器在辅助治疗静脉血栓中的作用

目的探讨腔静脉滤器置入在外周静脉血栓患者溶栓治疗中预防异位栓塞的应用价值.材料和方法7例下肢静脉血栓及1例永存动脉干合并右颈内静脉血栓的患者,分别经静脉置入永久性腔静脉滤器或临时性腔静脉滤器后,用大量尿激酶顺行或全身静脉溶栓治疗.结果8例患者经10～15天治疗后症状消失,血栓完全或部分溶解,血管开通,未出现并发症及异位栓塞.结论置入腔静脉滤器在外周静脉血栓患者溶栓治疗中是预防静脉血栓脱落导致异位栓塞的有效方法.     

腔静脉滤器置入并静脉溶栓治疗并发症的观察及护理

目的 探讨腔静脉滤器置入并静脉溶栓治疗并发症的观察及护理方法.方法 2007年7月-2010年3月开展腔静脉滤器置入并静脉溶栓治疗70例,针对主要并发症进行观察,包括出血倾向、肺栓塞、滤器移位、脱落、滤器血栓闭塞、滤器穿破下腔静脉、患肢静脉功能不全及患肢皮肤水疱的观察和护理.结果 70例溶栓治疗的总有效率为95.7%(...     

下腔静脉滤器置入及介入溶栓治疗下肢静脉血栓

肺动脉栓塞是一种危及生命的严重病症,大多是由于下肢及盆腔的静脉血栓形成后栓子脱落进入右心,继而阻塞肺动脉及其分支引起,该病死亡率较高,临床危害极大.下腔静脉滤器经皮经股静脉穿刺置入术已被公认为有效的预防方法,并在临床上得到广泛应用[1].我院自1999年1月～2003年12月选择有肺动脉栓塞高危因素的髂股静脉系统血栓形成患者,采用经皮经股静脉穿刺置入下腔静脉滤器后插管溶栓治疗共11例,均获得成功,现总结报告如下.     

腔静脉滤器的安放

病例：2例，男女各一例，年龄45岁一例，40岁一例，其中一例因外伤后，双下肢肿胀，疼痛，发疳，伴呼吸困难，咳嗽，气短，临床诊断：双下肢静脉血栓伴肺动脉血栓，经肺动脉造影，诊断为右肺上叶动脉及右肺下动脉部分血栓形成，经导管经行肺动脉溶栓后，患者呼吸道症状好转。另一例不明原因左下肢肿胀，疼痛，发疳，临床诊断：左下肢静脉血栓。     

下腔静脉滤器植入后溶栓治疗下肢深静脉血栓的疗效分析

下肢深静脉血栓形成（DVT）是一种严重而具有潜在危险的疾病,不进行抗凝治疗,将有1／3的患者发生肺动脉栓塞,严重者造成死亡。下腔静脉滤器植入术（VCF）可有效预防致命性肺栓塞的发生,同时使溶栓治疗更为安全。我院自2003年8月～2008年12月对26例下肢深静脉血栓患者行下腔静脉滤器植入加溶栓术,取得了良好效果,现总结如下。     

置管溶栓术治疗下腔静脉滤器内栓子的疗效观察

目的 评价置管溶栓术治疗下腔静脉滤器内栓子的疗效及安全性.方法 2005年1月至2010年12月对31例经造影证实的下腔静脉滤器内存在栓子患者进行置管溶栓术治疗,栓子最大径均超过1 cm,溶栓药物采用尿激酶,用量为每日60万u,疗程为3～7d,术后观察临床疗效及并发症.结果 经置管溶栓治疗,18例栓子消失,7例栓子最大径缩小至3 mm以下,6例无明显变化.并发症有穿刺点渗血5例,血尿3例,腹膜后血肿1例,无严重并发症发生.并发症经对症治疗恢复良好.25枚滤器被成功取出,6枚滤器被留置.滤器取出术中及术后无急性肺栓塞发生.结论 置管溶栓术是治疗下腔静脉滤器内栓子安全、有效的方法,能提高下腔静脉滤器的取出率.     

下腔静脉滤器置入及动脉导管溶栓治疗下肢深静脉血栓68例

肺动脉栓塞（pulmonary embolism,PE）是一种危及生命的严重疾病,大多是南了下肢深静脉血栓及盆腔静脉血栓形成（deep vein thrombolytic,DVT）后栓子脱落进入下腔静脉及右心,进而阻塞肺动脉及分支引起。该病病死率高,临床危害极大。     

可回收下腔静脉滤器联合导管持续溶栓治疗急性下肢深静脉血栓形成

目的 评价可回收下腔静脉滤器联合导管持续溶栓治疗急性下肢深静脉血栓形成(DVT)的安全性和临床效果.方法 回顾性分析2012年1月至12月收治的76例急性下肢DVT患者,均在DSA导引下置入下腔静脉滤器,然后置放溶栓导管于血栓段,经导管24 h持续微泵灌注50万U/d尿激酶.根据患者髂股静脉再通情况、住院时间、治疗前后肢体周径差、治愈率、并发症等评估近期疗效和安全性;随访1年,根据患者下肢水肿、髂股静脉闭塞、色素沉着、溃疡等评估远期疗效.结果 76例患者均成功置入下腔静脉滤器(14 d后成功回收71例),治疗14d后临床症状均不同程度缓解,髂股静脉血流基本或全部恢复,平均住院时间为(6.7±3.1)d.治疗后3、7、14 d肢体周径与治疗前比较明显缩小(P＜0.05),治疗期间未出现严重不良反应.下肢静脉彩色超声复查显示,随访6个月时髂股静脉闭塞率和色素沉着率分别为5.3％(4/76)和2.6％ (2/76),随访12个月时分别为9.2％(7/76)和7.9％ (6/76),未发生皮肤溃疡.结论 可回收下腔静脉滤器联合导管持续溶栓治疗急性下肢DVT可取得较好的近远期临床效果,安全可行.     

下腔静脉滤器在下肢深静脉血栓形成治疗中的应用

下肢深静脉血栓形成(deep vein thrombosis,DVT)是一种常见的血管疾病,下肢DVT的主要并发症是肺动脉栓塞(pulmonary embolism,PE)和下肢深静脉血栓后综合征(post-thrombotic syndrome,PTS).当肺动脉栓塞80％以上时,常导致患者死亡,即致死性肺梗死[1],也是最严重的并发症,且死亡率高达31％～41％[2].下腔静脉滤器置入后,降低了下肢DVT患者血栓脱落并导致PE的可能性,而且及时行溶栓及抗凝治疗,可减少PTS的发生.我院2005-01～2010-09对17例DVT患者行下腔静脉滤器(inferior vena cava filter,IVCF)置入术,术中患肢置管溶栓,术后行患肢溶栓治疗,取得良好效果,现报道如下.     

球囊扩张辅助经导管直接溶栓导致下腔静脉滤器栓塞及其处理

目的探讨球囊扩张辅助经导管直接溶栓(CDT)治疗急性下肢深静脉血栓形成(DVT)过程中下腔静脉滤器(VCF)血栓阻塞的发生率及其处理。方法 2009年9月至201 1年5月收治44例急性下肢DVT患者,作下腔静脉VCF保护下行球囊扩张辅助CDT治疗。结果 27.3%(12/44)患者因VCF拦截大量血栓导致下腔静脉阻塞(完全闭塞8例,部分闭塞4例),经CDT治疗后1 1例完全通畅,1例部分通畅(造影表现为VCF远端充盈缺损)。治疗前后下腔静脉通畅度评分差异有统计学意义(X~2=48.2,P=0.000)。88.64%(39/44)的患者放置可取出VCF,治疗结束后均全部顺利取出。主要并发症包括穿刺点出血13.6%(6/44)、肉限血尿4.5%(2/44)、痰中带血4.5%(2/44),未发生症状性肺栓塞。结论球囊扩张辅助CDT治疗急性下肢DVT可能发生血栓脱落,由此导致的急性VCF血栓阻塞经CDT治疗效果良好。     

下腔静脉滤器置入后大剂量尿激酶溶栓治疗下肢深静脉血栓形成

目的　探讨下腔静脉滤器置入后大剂量尿激酶溶栓治疗下肢深静脉血栓形成的可行性。方法　 1 3例经造影证实为左下肢深静脉血栓患者 ,先于下腔静脉内放置滤器 ,后在监护下经患者足背静脉加压推注尿激酶进行持续溶栓治疗 ,尿激酶 (UK)用量 90 0万U～ 1 60 0万U。疗效判断标准 :痊愈 :患者无症状 ,下肢造影示深静脉通畅 ;显效 :患者症状明显缓解 ,下肢造影示深静脉回流畅 ,但壁不光滑 ,血管内径 >70 % ;有效 :症状有所缓解 ,造影示血栓残留 ,血管内径 <70 % ;无效 :症状及下肢造影均无改善。结果　 1 3只下腔静脉滤器均展开良好 ,无移位。其中 :痊愈 2例 ,显效 9例 ,有效 2例 ,无效 0例 ,溶栓过程中未出现肺动脉栓塞症状及出血现象。结论　下腔静脉滤器置入后经患肢浅静脉大剂量尿激酶溶栓治疗下肢深静脉血栓形成是安全、有效的     

Misplacement of a vena cava filter in the retroperitoneum

An inferior vena cava filter was misplaced into the pericaval retroperitoneum. This was probably secondary to placement into and avulsion of the right spermatic vein. The filter delivery system was modified, and such misplacement should now be impossible.     

Deep venous thrombosis and inferior vena cava malformation

We report on five patients with anomalies of the inferior vena cava who all presented with deep venous thrombosis. The anomalies of the inferior vena cava were diagnosed with CT, and at the same time thrombosis of the inferior vena cava and/or iliofemoral thrombosis could be demonstrated. Malformation of the inferior vena cava might be a predisposing factor for deep venous thrombosis. Correspondence to: B. Bollinger     

New retrievable percutaneous vena cava filter: Experimentalin vitro andin vivo evaluation

A new retrievable percutaneous vena cava filter was testedin vitro andin vivo in 15 foxhounds.In vitro, the new vena cava filter was compared with the standard Kimray-Greenfield filter and the Günther basket filter. The new filter is a stainless steel half-basket filter and is suitable for percutaneous antegrade or retrograde insertion through a 8.5 Fr introducer sheath.In vitro testing showed the filter causing no significant flow alterations and being highly effective in capturing medium- and large-sized thrombi; furthermore, fatigue testing revealed no breakage of the new filter, whereas the Günther basket filter showed breakage of the struts.In vivo studies showed no occlusion, major perforation, or filter migration during follow-up of 2 weeks to 6 months. Tilting of the filter postimplantation occurred in two out of 28 filters. Ten of 11 filters were successfully retrieved by the transjugular approach 2 weeks after implantation. The device seems to be suitable for temporary or permanent protection against pulmonary embolism. This article is based in part on the thesis written by Kirsten Tonn, and was presented at the CIRSE'92 Annual Meeting in Stiges, Barcelona, Spain on August 30, 1992     

Pulse-spray thrombolysis of inferior vena cava thrombosis complicating filter placement

Inferior vena cava thrombosis is an uncommon but potentially serious complication of caval filter placement. A 34-year-old man with symptomatic caval thrombosis, which occurred 6 weeks after filter placement, was successfully treated with a combination of pulse-spray and local infusion of urokinase.     

经皮穿刺下腔静脉滤器置入术

目的 评价下腔静脉滤器预防肺动脉血栓栓塞的作用。方法 ２８例下肢深静脉血栓形成患者实施了经皮穿刺下腔静脉小 置入术,２６例置入岛巢式滤器,２例置入Ｓｉｍｏｎ Ｎｉｔｉｎｏｌ滤器。结果 滤器全部置入肾静脉下方的下腔静脉内。２７例随访２￣３４个月,滤器无移位,１５例不伴有肺动脉血栓栓塞者无肺栓塞发生。结论下腔静脉滤器用于预防肺动脉血栓栓寒是一种安全有效的方法。     

Results of a multicenter study of the retrievable Tulip vena cava filter: Early clinical experience

Purpose To evaluate clinically a new, retrievable vena caval filter in a multicenter study. Methods The Tulip filter is a stainless steel half-basket that is suitable for antegrade or retrograde insertion via an 8.5 Fr introducer sheath. The filter can be retrieved via the jugular approach using an 11 Fr coaxial retrieval system. Forty-eight filters were implanted via the femoral approach and 38 via the jugular approach in 83 patients. Follow-up examinations (plain films, colorcoded duplex sonography) were performed up to 3 years after filter insertion (mean 136 days) in 75 patients. Twenty-seven patients were screened by colorcoded duplex sonography for insertion site thrombosis. Results An appropriate filter position was achieved in all cases. Insertion problems occurred in 3 cases; these were not due to the filter design but to an imperfect prototype insertion mechanism that has now been modified (n=2) or a manipulation error (n=1). In 2 of these cases the filters were replaced percutaneously; 1 patient required venotomy for filter removal. No further complications due to filter insertion occurred. Two filters were used as temporary devices and were successfully removed after 6 and 11 days, respectively. There was 1 fatal recurrent pulmonary embolism (PE) and 2 non-fatal PE, 5 complete and 3 partial caval occlusions, and 3 caudal migrations of the filter. Insertion site venous thrombosis was not seen in the 27 patients monitored for this complication. Conclusion Precise placement of the Tulip filter is feasible by either access route and the device appears mechanically stable. Further observations are needed to confirm that safe filter removal is practical up to 10 days after its insertion.     

Multisegmental anomaly of the inferior vena cava with thrombosis of the left inferior vena cava

We present a rare case of an extensive venous thrombosis associated with a multisegmental anomaly of the inferior vena cava (IVC), double IVCs, a hypoplastic right IVC, an aneurysm arising at the distal portion of the right IVC, and a severe stenosis between the prerenal and the hepatic segments of the IVC.     

可回收下腔静脉滤器预防肺栓塞实验研究

目的：评价新型可回收下腔静脉滤器(RNIVCF)的稳定性、血栓捕获能力、可回收性及安全性。方法：体外实验评定RNIVCF捕获直径2．5、3和4mm混合血栓的能力。实验犬12只，10只经股静脉注入直径2．5mm自体不透X线混合血栓，评价RNIVCF血栓捕获能力；2只在置入RNIVCF后第7天尝试取出。摄腹部及胸部平片验证滤过效果。结果：体外实验证实RNIVCF捕获了直径3和4mm混合血栓的100%，直径2．5mm混合血栓的95％～100％。成功地在12只犬下腔静脉(IVC)经皮置入13枚RNIVCF，其中1只犬为双IVC，置入2枚滤器。lO只犬体内的11枚RNIVCF成功地捕获了经股静脉注入的直径2．5mm的混合血栓，无一死亡。2枚滤器在置入后第7夫经皮回收没有困难。结论可回收滤器既可以长期留置，又可以临时置入，更为实用。优点：①可经皮经5F输送器置入及回收；②滤器无钩刺，对腔静脉壁无损伤；③置入后稳定；④捕获小血栓有效。     

Abdominal pain: a presentation of a vena cava aplasia complicated by thrombosis

This case report describes a young man presenting with iliac fossa pain secondary to iliac vein thrombus due to inferior vena cava aplasia. No other identifiable risk factor or cause for deep vein thrombosis was demonstrated.