导管溶栓联合支架植入术治疗急性髂股静脉血栓形成

目的比较经导管溶栓联合髂静脉支架植入与单纯导管溶栓治疗急性髂股静脉血栓形成的效果。方法选择经抗凝及导管溶栓治疗后存在严重髂静脉狭窄的急性髂股静脉血栓形成病人86例，其中32例经导管溶栓后，联合球囊扩张支架植入术开通髂静脉（观察组）；另54例单纯行导管溶栓治疗（对照组）。统计血栓消除率、肢体肿胀缓解情况及围手术期并发症；术后第3、6、12、24个月分别采用Villalta评分量表和Vcss量表评估血栓形成后综合征（PTS）发生情况及静脉临床症状严重程度。结果2组经导管溶栓治疗血栓Ⅲ级消除率达82.6%；溶栓时间、尿激酶用量、住院时间、围手术期并发症、PTS的发生率及血栓复发率差异均无统计学意义（P>0.05）；观察组膝上15 cm周径差较对照组小（P < 0.05）；随访3、6、12、24个月，观察组Villalta体征和症状评价、Vcss评分均低于对照组（P < 0.05~P < 0.01）。结论经导管溶栓治疗急性髂股静脉血栓形成血栓清除率高，联合球囊扩张支架植入术开通髂静脉有助于改善症状，提高临床治疗效果。

Analysis of the efficacy of catheter-directed thrombolysis combined with stent implantation in the treatment of acute iliofemoral vein thrombosis

ObjectiveTo compare the effects between catheter-directed thrombolysis combined with iliac vein stent implantation and catheter-directed thrombolysis in the treatment of acute iliofemoral vein thrombosis.MethodsThe clinical data of 86 patients with acute iliofemoral vein thrombosis complicated with severeiliac vein stenosis treated with anticoagulation combined with catheter-directed thrombolysis were retrospectively analyzed.Thirty-two patients treated with catheter-directed thrombolysis combined with balloon dilatation and stent implantation to open iliofemoral vein and 54 patients treated with catheter-directed thrombolysis alone were divided into the observation group and control group, respectively.The thrombosis elimination rate, limb swelling relief and perioperative complications were counted.The occurrence of post-thrombotic syndrome(PTS) and severity of venous clinical symptoms in two groups after 3, 6, 12 and 24 months of operation were evaluated using Villalta scale and Vcss scale.ResultsThe elimination rate of grade Ⅲ thrombus in two groups by catheter-directed thrombolysis was 82.6%.There was no statistical significance in thrombolytic time, urokinase dosage, length of stay, perioperative complications, incidence of PTS and thrombus recurrence rate between two groups(P>0.05).The circumference difference of up 15 cm of knee in observation group was smaller than that in control group(P < 0.05).During the following-up 3, 6 12 and 24 months, the Villalta signs and symptoms evaluation and Vcss score in observation group were smaller than those in control goup(P < 0.05 to P < 0.01).ConclusionsThe thrombus clearance rate of catheter-directed thrombolysis in the treatment of acute iliofemoral venous thrombosis is high, which combined with opening iliofemoral vein with balloon dilatation and stent implantation can improve the symptoms and clinical therapeutic effect.