混合型下肢深静脉血栓综合介入治疗的并发症及其对策

目的:探讨混合型下肢深静脉血栓(LEDVT)综合介入治疗的并发症及治疗对策.方法:回顾性分析7年间采用综合介入治疗的488例急性或亚急性混合型DVT患者的临床资料.所有患者先行下腔静脉滤器植入,再行机械性血栓碎吸、导管溶栓、抗凝等治疗；如合并症状性肺栓塞,则行肺动脉导管溶栓治疗；如合并髂静脉狭窄或闭塞同时行球囊扩张血管成形术(PTA)或支架植入治疗.结果:症状性肺栓塞发生率为7.58％ (37/488),2例(2/37)抢救无效死亡.综合介入治疗中血管损伤发生率为9.22％ (45/488),滤器拦截大块血栓的发生率为16.60％ (81/488).术后抗凝过程中发生异常出血率5.53％ (27/488),2例患者因脑出血死亡.451例患者获随访4～94(平均41)个月,血栓后综合征(PTS)发生率11.53％ (52/451)；PTA后出现静脉再堵塞发生率为40.19％ (43/107)；支架植入后静脉再堵塞发生率为6.6％ (7/106).结论:综合介入疗法治疗混合型下LEDVT有一定的并发症发生率,应采取各种措施加以预防.

Integrated interventional treatment for mixed type of lower extremity deep vein thrombosis: complications and management

Objective: To investigate the complications of integrated interventional treatment for mixed type of lower extremity deep vein thrombosis (LEDVT) and their management. Methods: The clinical data of 488 patients with acute or subacute mixed type LEDVT treared during 7 years were retrospectively analyzed. All patients underwent inferior vena cava filter placement, and subsequently underwent mechanical thrombus fragmentation and aspiration, catheter-directed thrombolysis and anticoagulant therapy. Intrapulmonary catheter-directed thrombolysis was performed in patients with symptomatic pulmonary embolism (PE), and balloon dilation angioplasty (percutaneous transluminal angioplasty, PTA) or post-PTA stent insertion was performed in patients with iliac vein stenosis or occlusion. Results: The incidence of symptomatic PE was 7.58% (37/488), and 2 of the PE patients (2/37) died in spite of aggressive salvage attempts. The incidence of vascular injury and large thrombus trapped by the filter during the integrated interventional treatment was 9.22% (45/488) and 16.60% (81/488), respectively. The incidence of abnormal bleeding during postoperative anticoagulation was 5.53% (27/488), and 2 of these patients died due to intracerebral hemorrhage. Four hundred and fifty-one patients were followed up for 4 to 94 months with average period of 41 months, during which time, the incidence of post-thrombotic syndrome (PTS) was 11.53% (52/451), and the incidence of post-PTA restenosis and reocclusion after stent placement was 40.19% (43/107) and 6.6% (7/106), respectively. Conclusion: Integrated interventional treatment for mixed type of LEDVT carries a certain risk of complications, so several preventive measures should be taken.