双股静脉入路治疗髂-股静脉血栓的临床研究

目的　探讨应用双股静脉入路技术 ,治疗髂 -股静脉血栓 (I -FVT)的有效性。方法　下肢深静脉顺行造影证实为I -FVT患者 18例。经健侧股静脉置入下腔静脉滤器 ,然后经健侧股静脉置管于患侧髂静脉入下腔静脉处造影。导丝导管无法进入患侧髂 -股静脉者 ,行患侧股静脉穿刺插管 ,顺行开通股 -髂静脉至下腔静脉内。随后再经健侧插管至患侧开通段内 ,并继续开通下方的闭塞段。对开通段用球囊导管顺次扩张、拖拉 ;对闭塞段中较松软的血栓应用血栓消融器 (ATD)或溶栓导管 (OASIS)进行消融或抽吸术 ;术后保留导管 1～ 6d ,持续行接触性溶栓与抗凝治疗 ,撤管后继续行严格抗凝、溶栓治疗。结果　 18例经双股静脉入路治疗者 ,15例取得明显的疗效 ,表现为患肢肿胀迅速消退 ,疼痛消失 ,肢体松软 ,活动恢复正常 ;另外 2例开通后 ,患肢肿胀减轻 ,好转出院 ;1例未能开通 ,经同侧足背静脉静滴抗凝、溶栓药物 ,症状好转出院。全部病例均未发生肺梗死。术后随访 3～ 39个月 ,平均 16.4个月 ,无症状性复发。结论　双股静脉入路治疗I -FVT ,是一种较为简便、安全、有效的方法

Clinical Study on Treatment of Iiiac-Femoral Venous Thrombus Via Double Femoral Veins

Objective To evaluate the efficiency of treatment of iliac-femoral venous thrombus(I-FVT)via double femoral veins.Methods Eighteen patients with I-FVT were treated with implantation of inferior vena caval filter,catheter-directed cut,balloon-directed extend and drag.Some patients were treated with ATD or OASIS catheter.After operation,the catheter was kept in iliac-femoral veins for one to six days.Meanwhile,strict anti-coagulation was necessary.Results The treatment was successful in seventeen patients,the iliac-femoral veins were patent after the opration.Swollen symptom of lower limb and pain disappeared in fifteen patients,swollen symptom of lower limb became better in two patients.The treatment was fail in one patient.Follow-up study showed no pulmonary embolization or recrudescence in all eighteen patients.Conclusion The treatment of I-FVT via double femoral veins is a safe and effective method,there are no serious complications.