机械性血栓切除和开通治疗慢性血管内血栓

目的　探索机械性血栓切除和开通治疗慢性血管内血栓的可行性 ,初步分析疗效并讨论适应证、禁忌证。方法　本组 2 3例患者血管内血栓均行MRA、血管超声及血管造影证实。其中 12例患有慢性心力衰竭和 (或 )血管性疾病 ,11例为重度糖尿病 ,血栓位于髂动脉 10例 ,股动脉 2例 ,动脉3例 ,髂静脉 7例 ,门静脉 1例。血栓长度为 3～ 8cm ,血栓直径为 5～ 10mm。 7例髂静脉血栓患者行血栓物理性治疗前先行放置下腔静脉滤器。射频消融 (ATD)治疗 9例 (7例静脉 ) ,经皮电动网篮 (PTD) 2例 (门静脉 ) ,流变溶栓 (OASIS) 3例 (动脉 2例 ,静脉 1例 ) ,内支架直接开通 9例 (均为动脉 )。所有患者在血栓治疗过程中采用 5 0万U的尿激酶通过导管内直接进行溶栓。物理性血栓切除后如造影证实血管狭窄者于狭窄部行血管内支架放置。术后治疗包括内科溶栓、肝素抗凝和改善微循环等药物治疗。随访包括血管超声、CT血管重建随访及临床症状随访。结果　 12例 (85 .7% )成功进行了物理性血栓切除。 1例门脉血栓者失败 ,1例股动脉血栓患者同时进行ATD和OASIS治疗。 2 1例 (91.3% )患者症状明显改善和消失 ,包括缺血、肿胀、活动受限。血管超声随访血管通畅率 :10 0 % (3个月 ) ,85 .4 % (6个月 ) ,73.2 % (12个月 ) ;同时 3个月、

Interventional mechanical thrombectomy treatment for chronic vascular thrombus

Objective To investigte the possibility of interventional mechanical thrombectomy dealing with chronic vascular thrombus, and assessing its curative effects. Methods Twenty three cases included 17 males 6 females, and aged from 46 to 80 year with a mean of 64.8. All patients were coinsided with MRA, vascular ultrasound and angiography, in which 12 patients with chronic heart and vascular disease, and 11 patients with serious diabetes. Thrombi were located in iliac artery ( n=9,L=4,R=3 , bilaterals=2), femoral artery( n =2), populiteus artery ( n =2), popliteus artery( n =3), iliac vein ( n =7, L=5,R=2), portal vein ( n =1). The length of thrombi varied from 3 to 8 cm, and the diameter from 5 to 10mm.Filter should be placed in inferior cava vein before venous thrombus treatment ( n =7). Mechanical thrombectomy was undertaken as following: ATD ( n=9, Vein=7), PTD( n =2), and Oasis( n =1). After guide wire passing through thrombus segment, Oasis was inserted for remove thrombus. Urokinase (500 000U) was usually administered for catheter directed thombolysis before/during mechanical thrombectomy. Stent should be placed in the segment if stenosis was confirmed after thrombectomy angiography. Drugs were used after thrombectomy including thromboyltic drug, heparinzed anticoagulation and changing microcirculation. Vascular ultrasound, reconstruction CTA and clinical follow up had all been carried out. Results 12 cases (85.7) were undergone successfully thrombectomy. One case failured with portal vein thrombus formation, the other with multiple segments involvement in femoral artery was treated by combined ATD and Oasis. Sy mptoms of 15 cases were either released or disappared, including ischemia, swelling and motion limitations. The patency shown by vascular ultrasound follow up were 100% in three months, 85.4% in six months, 73.2% in twelve months, with simultaneously blood flow improvement to normal and obviously corrected 76.5%,65.4% 60.1% in 3,6,12 month respectively.Conclusions Interventional mechanical thrombectomy is a new choice of treating chronic vascular thrombus with its direct curative effects, but still needs long term follow up.