下腔静脉滤器在急性下肢深静脉血栓形成导管溶栓治疗中的必要性探讨

目的 探讨急性下肢深静脉血栓形成(deep venous thrombosis,DVT)患者行导管溶栓治疗(catheter direct thrombolysis,CDT)时,置入下腔静脉滤器的必要性.方法 回顾性总结2006年11月至2008年12月在仁济医院(东院)血管外科,经CDT及后续腔内治疗的急性下肢DVT患者临床资料.全组93例(93侧肢体),其中男35例,女58例;左下肢80例,右下肢13例;年龄28～88岁,平均60±29岁.病程5 h至15 d,平均(6.28±7.08)d.结果 93例患者中,置入滤器者30例,未置滤器者63例(67.7%,63/93).左下肢DVT未置滤器者占93.6%(59/63).溶栓后复查数字减影造影(digital subtraction angiography,DSA),77例髂-股静脉血栓完全溶解,其中70例于患肢髂静脉检出狭窄或闭塞性病变,57例接受了后续腔内治疗.全组未发生症状性肺栓塞(pulmonary embolism,PE).术后肺CTA检查:3例PE,均为置入下腔静脉滤器者;1例可疑PE,系未置入滤器者.结论 对于左下肢DVT且血栓未累及下腔静脉者,行CDT治疗时不必常规置入腔静脉滤器.

Inferior vena cava filter is not always necessary during catheter directed thrombolysis for deep vein thrombosis

Objective To explore the necessity of inferior vena cava(IVC) filter implantation during catheter directed thrombolysis (CDT) for acute deep vein thrombosis (DVT). Method Ninety-three patients with acute DVT were reviewed from Nov. 2006 to Dec. 2008. There were 35 men and 58 women, age averaging at (60 ±29) year old, treated with CDT followed by percutaneous transluminal angioplasty ( PTA). The course of DVT was from 5 h ～ 15 d (6. 28 ±7.08) d with 80 left lower limbs and 13 right lower limbs involved. Results There were 30 patients with prior IVC filter implanted compared with 63 patients without filters (67. 7% ,63/93). Among the patients without filter, there were 93. 6% (59/63) left lower limbs. DSA was redone after thrombolysis. Seventy-seven iliacfemoral thrombosis was resolved completely and stenosis or occlusion of the iliac vein were found in 90. 9% (70/77) cases. Endovascular treatment was performed in 57 patients. There was no patients suffering from symptomatic pulmonary embolism (PE). PE was found in 3 cases with a filter and 1 case without filter was suspected of PE on pulmonary CTA after treatment. Conclusion It is not necessary to routinely place an IVC filter during CDT for treating DVT on left lower limb when the thrombosis is not involing the IVC.