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。

DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis for acute lower extremity deep venous thrombosis

Objective: To investigate the efficacy of DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis for acute lower extremity deep venous thrombosis (DVT). Methods: From August 2012 to November 2016, 87 patients with mixed type and central type acute lower extremity DVT underwent DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis. Effectiveness evaluation was performed by comparison of the limb circumference differences before and after thrombolysis and observation of the angiographic evidence of deep venous patency after thrombolysis. Results: Of the 87 patients, successful puncture was performed in 80 cases (91.9%), of whom 68 cases underwent posterior tibial vein puncture and 12 cases underwent anterior tibial vein puncture; 7 cases with failed puncture underwent catheterization by posterior tibial vein incision. Clot fragmentation combined with catheter-directed thrombolysis was performed in all patients after successful catheterization. Compared with findings before thrombolysis, the limb circumference difference was significantly reduced (4.28±1.02) cm vs. (1.06±0.42) cm] and venous patency score was significantly decreased (10.25±1.84) vs. (1.92±0.5)], and all differences had statistical significance (all P<0.05). Conclusion: DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis is a simple and effective method for treatment of acute lower extremity DVT.