特发性肝下下腔静脉长段闭塞合并血栓的介入治疗

目的 评价特发性肝下下腔静脉长段闭塞合并血栓的介入治疗效果.方法 14例特发性肝下下腔静脉长段闭塞合并血栓的患者,均在局麻下经颈静脉途径联合经股静脉途径施行介入治疗,先行经导管尿激酶溶栓术,再对下腔静脉闭塞段行球囊扩张和(或)支架置入术.结果 血管造影示闭塞段位于下腔静脉肝后段至肾下段3例,位于肝下肾静脉上段11例,血栓位于下腔静脉内14例,蔓延至髂股静脉12例.治疗成功12例,下腔静脉全部开通,血栓完全溶解8例,部分溶解4例.不成功2例.8例患者平均随访(12±6)(1～36)个月,无血栓复发,下腔静脉无症状性再狭窄1例.结论 介入治疗特发性肝下下腔静脉长段闭塞合并血栓是一种安全、有效的方法.

Interventional treatment of idiopathic long-segment occlusion of infrahepatic inferior vena cava complicated with thrombosis

Objective To evaluate the efficacy of interventional treatment of idiopathic longsegment occlusion of infrahepatie inferior vena eava(IVC)complicated with thrombosis.Methods Fourteen patients with idiopathic long-segment occlusion of infrahepatie IVC complicated with thrombosis underwent endovaseular recanalization.All procedures were performed under local anesthesia via internal jugular vein in combination with a unilateral femoral approach.First catheter-directed urokinase thrombolysis was performed.Then the occlusion of IVC was treated with balloon angioplasty and/or stent placement.Results Iliocavogram demonstrated an occlusion of IVC from intraheparic segment to infrarenal segment in 3 patients and an occlusion of infrahepatie IVC above renal veins in 11 patients.Thrombosis was located in IVC(n=14)and extended to iliofemoarl veins(n=12).Technical success was achieved in 12 patients.IVCs were reeanalized successfully.Complete or partial thrombua removal was accomplished in 8 and 4 cases,respectively.Recanalizafion failure occurred in 2 patients.No rethrombosis occurred over a mean follow-up of 12±6 months(range:1-36).And an asymptomatie restenosis of IVC was diagnosed by duplex scanning.Conclusion Intervenfional treatment of idiopathic long-segment occlusion of infrahepafie IVC complicated with thrombosis is a safe and effective method.