机械性血栓清除术联合同期髂静脉支架植入治疗合并左髂静脉受压综合征的急性下肢深静脉血栓形成

目的：评价经皮机械性血栓清除术联合同期髂静脉支架植入治疗合并左髂静脉受压综合征的急性下肢深静脉血栓（DVT）形成的可行性、安全性及有效性。 方法：选取2015年4月-2017年6月收治左髂静脉受压综合征伴急性下肢DVT的患者33例，发病时间6 h-14 d，平均年龄（57.97±14.44）岁。所有患者均在滤器保护下进行治疗。AngioJet血栓清除术、球囊扩张和髂静脉支架植入均在同期完成，术后保留鞘管予以溶栓治疗，每天复查造影，若血栓完全溶解，取出下腔静脉滤器并结束溶栓。术后第1、3、6、12个月进行门诊随访，行彩色超声和（或）下肢静脉造影检查了解下肢深静脉及髂支架内血流通畅情况。 结果：33例患者均同期完成手术，技术成功率100%，AngioJet抽吸时间为（224.70±72.78）s，溶栓时间（34.00±15.37）h，尿激酶用量（112.58±49.92）万U。33例患者同期植入髂静脉支架33枚。血栓清除率Ⅲ级患者29例，血栓清除率Ⅱ级患者4例。无出血、症状性肺栓等严重并发症发生。术后随访1例患者术后两月血栓复发，32例患者术后随访超声和（或）下肢静脉造影检查提示下肢深静脉及髂静脉支架内血流通畅。 结论：机械性血栓清除术联合同期髂静脉支架植入治疗合并左髂静脉受压综合征的急性下肢深静脉血栓形成是一种安全有效的方法。

Effect of percutaneous mechanical thrombectomy combined with subsequent iliac vein stent implantation in treatment of acute lower extremity deep venous thrombosis with iliac vein compression syndrome

Objective:To evaluate the feasibility, safety and effectiveness of percutaneous mechanical thrombectomy (PMT) combined with subsequent iliac vein stent implantation in treating acute deep venous thrombosis (DVT) with iliac vein compression syndrome (IVCS) . Methods:During the period from April 2015 to July 2017, 33 patients who had acute DVT with IVCS, including 13 males and 20 females with a mean age of (57.97±14.44) years old, were admitted to The First Affiliated Hospital of Soochow University. The disease time was 6 h-14 d. Inferior vena cava filters were implanted in all patients prior to the treatment. AngioJet thrombectomy, balloon angioplasty and iliac vein stent implantation were performed in the same setting. All patients received continuous transcatheter infusion of urokinase until the thrombosis was confirmed to be completely dissolved. The patients were followed up at outpatient clinic at 1, 3, 6 and 12 months after treatment, and the reexamination of color ultrasound and/or lower limb venography were used to assess the blood flow in deep veins and stents. Results:The combination of several therapies was accomplished in a single session, the technical success rate was 100%. The procedure time for AngioJet thrombectomy was (224.70±72.78) s. The thrombolysis time was (34.00±15.37) h. The total used dosage of urokinase was (112.58±49.92) ×10⁴ U. Thirty-three stents were implanted directly after thrombectomy in 33 patients. Angiography postoperatively showed thrombus clearance rate of grade Ⅲ was obtained in 29 patients and was grade Ⅱ in four patients. There were no serious complications such as pulmonary embolism, severe hemorrhage, etc. Relapse of DVT was observed in one patient, color ultrasound and/or lower limb venography performed in the other 32 patients showed that the blood flow in deep veins and iliac vein stents was unobstructed. Conclusion:For the treatment of acute lower extremity DVT with IVCS, PMT combined with iliac vein stent implantation accomplished by single-session is safe and feasible.