经颈静脉Aegisy腔静脉滤器在下肢DVT导管溶栓治疗中的临床应用

目的探讨Aegisy腔静脉滤器在下肢深静脉血栓形成（DVT）经导管溶栓治疗中的临床应用价值。方法2008年4月～2009年8月间,45例下肢DVT患者（左侧：36例,右侧：6例,双侧：3例,4例已发生肺栓塞）在经颈静脉插管溶栓过程中行Aegisy腔静脉滤器置入术,以防止肺动脉栓塞。结果45支Aegisy腔静脉滤器经颈静脉一次性于下腔静脉植入成功,技术成功率100%,术中未出现滤器错位、移位、倾斜、滤器折断、腔静脉穿孔、下腔静脉阻塞等并发症。在溶栓治疗过程中1例肺动脉栓塞患者因右心衰竭死亡,其他患者无症状性肺动脉栓塞发生。溶栓治疗后,45支滤器中的36只成功取出,滤器留置时间为7～18天（平均9.5天）,余9支滤器永久性留置于患者体内。随访2～17个月（平均9.7个月）,滤器无移位及血栓形成。结论Aegisy腔静脉滤器经颈静脉途径植入方法简单、释放可控、安全,可有效防止症状性肺动脉栓塞。

Clinical Application of Aegisy Vena Caval Filter in Transcatheter Thrombolytic Therapy of Deep Venous Thrombosis of Lower Extremity via Jugular Vein Approach

Objective To investigate the value of Aegisy vena cava filter in the deep vein thrombosis（DVT） by transcatheter thrombolytic therapy.Methods To prevent pulmonary artery embolism,45 cases of deep venous thrombosis of lower limbs（left,n=36;right,n=6;left and right,n=3;PE,n=4）from April 2008 to August 2009 underwent planting of the Aegisy vena cava filter in Catheter-directed thrombolysis with urokinase.Results Forty-five Aegisy vena cava filters were implanted in 45 patients with lower extremity DVT.The technical success rate was 100%,without filter migration,filter tilting,filter fracture,IVC perforation,or IVC thrombotic obstruction.One case of PE died,and in the others no detectable PE or recurrent PE was observed in thrombolytic therapy.Thirty six of 45 filters were successfully removed out,with filter stayed in body for 7-18 days（average 9.5 days）.In 9 filters with permanent retention,filter migration and thromboses were not detected during the follow-up of 2-17 months（average 9.7 months）.Conclusion Planting of Aegisy vena cava filter is simple,controllable and safe via jugular vein approach.It is effective to prevent symptom pulmonary embolism in the process of thrombolytic therapy of the deep venous thrombosis of lower limbs.