数字减影血管造影下手术取栓及溶栓等综合治疗急性下肢深静脉血栓

目的：总结严重急性下肢深静脉血栓形成（DVT）治疗的经验，探讨其治疗方法。方法：30例（中央型4例，混合型26例）不同发病时间的严重急性下肢DVT患者，采用下腔静脉滤器置入，在数字减影血管造影（DSA）监视下手术切开股静脉，用Forgarty球囊导管清除髂股静脉内血栓，继之用尿激酶或巴曲酶、肝素、低分子右旋糖酐等溶栓、抗凝、祛聚治疗。术后通过DSA造影或下肢彩色多谱勒超声检查，观察下肢深静脉通畅情况和瓣膜功能。结果：术后即刻下肢胀痛显著好转，25例7－10天后无下肢肿胀，5例下床活动后患肢轻度肿胀；行DSA或下肢彩色多谱勒超声检查，显示下肢深静脉血流通畅，无严重并发症和死亡。术后随访3个月，27例无肢体不适，下肢深静脉血流通畅，瓣膜功能良好；3例患肢深静脉瓣膜关闭不良。本组患者术后无肺栓塞表现。结论：严重急性下肢DVT行DSA下手术，可保证取栓的彻底性，提高术后溶栓、抗凝、祛聚治疗的效果。发病时间超过1周者，亦可采用上述综合治疗方法。

Thrombectomy monitoring by DSA combined with thrombolytic therapy for deep venous thrombosis of lower extremities

Objective: To study the therapy strategy for acute deep vein thrombosis (DVT) of lower extremity. Methods: Thirty patients with acute DVT were analyzed retrospectively that included centre type 4 cases and mixed type 26 cases. All cases underwent surgical thrombectomy after vena cava filter placement. The operation were performed within 3 days after the onset of thrombosis in 6 cases, within 7 days in 13 cases , within 14 days in 13 cases and 1 patient was in 25 days after. Forgarty balloon was used to remove thrombus. Imaging was performed directly by digital subtraction angiography (DSA) to avoid residual thrombus during operation. The antithrombotic agents were given during and after operation. Follow-up data were obtained from all patients after 3 months. vein patency and valve function were assessed with duplex scanning or DSA. Results: The clinical symptoms obviously improved after operation in all patients. In 7 to 10 days, lower extremities edema disappeared in 25 cases and another 5 cases remained slightly. No death and serious complication happened in this series. Follow-up during 3 months, vein patency and valve function were restored in twenty-seven patients. They did not show clinical signs of post-thrombotic syndrome. Slightly leg swelling was found in 3 cases with valve dysfunction. No patient had symptomatic pulmonary emboli. Conclusion: Thrombectomy monitoring by DSA combined with thrombolytic therapy to patients with severe DVT offers substantially good clinical outcome. Patients with onset of thrombosis beyond one week can be treated in this multidisciplinary approach.