经动脉序贯静脉置管溶栓治疗急性混合型下肢深静脉血栓26例的初步临床疗效观察

目的评价经动脉序贯静脉置管溶栓治疗急性混合型下肢深静脉血栓（lower extremity deep vein thrombosis，LEDVT）的安全性和有效性。 方法回顾性分析26例急性混合型LEDVT患者的临床资料。患者术前置入下腔静脉滤器，穿刺左侧肱动脉于患侧髂动脉置管溶栓，2～3 d后复查造影并穿刺患侧腘静脉行球囊扩张（percutaneous transluminal angioplasty，PTA）+手动抽栓（percutaneous mechanical thrombectomy，PMT）+置管溶栓（catheter directed thrombolysis，CDT）。观察血栓清除情况、患侧下肢周径变化情况及溶栓并发症等。 结果26例患者经动脉置管溶栓后24例（92.31%）腘静脉及膝下段深静脉血栓大部分溶解；之后行PTA+PMT+CDT操作1次者17例（65.39%），操作2次者7例（26.92%），操作3次后置入髂静脉支架者2例（7.69%）。血栓清除率Ⅲ级者22例（84.62%），Ⅱ级者2例（7.69%），I级者2例（7.69%）。治疗前膝上周径与健侧差值为（5.02±2.29）cm，治疗后差值为（0.74±0.18）cm，两者比较具有显著的统计学差异（t=7.601，P<0.001）。26例溶栓治疗无严重并发症。 结论经髂动脉置管溶栓序贯腘静脉PTA+PMT+CDT对于急性混合型LEDVT治疗安全有效。

Transarterial followed by transvenous catheter directed thrombolysis to treat acute mixed-type lower extremity deep venous thrombosis: preliminary clinical observation of 26 cases

ObjectiveTo evaluate the safety and efficacy of transarterial followed by transvenous catheter directed thrombolysis for acute treating mixed-type lower extremity deep vein thrombosis (LEDVT). MethodsClinical data of 26 patients with acute mixed-type LEDVT were retrospectively analyzed. All patients were performed insertion of inferior vena cava filter before operation. The left brachial artery was punctured to place thrombolysis catheter into the affected side iliac artery. After 2-3 days, angiography review was evaluated, and the affected popliteal vein was punctured to give percutaneous intraluminal angioplasty & percutaneous mechanical thrombectomy & catheter directed thrombolysis (PTA&PMT&CDT). The thrombus clearance, the decrease of the circumference of the affected lower extremity and complications were observed. ResultsAfter transarterial thrombolysis, 24 cases (92.31%) had the thrombosis dissolved in the popliteal vein and the veins below the knee. The PTA+PMT+CDT treatment was performed once in 17 cases (65.39%), 2 times in 7 cases (26.92%) and 3 times in 2 cases (7.69%) followed by iliac vein stents placement. The thrombus clearance rate was grade Ⅲ in 22 cases (84.62%), grade Ⅱ in 2 cases (7.69%), and grade I in 2 cases (7.69%). Before treatment, the difference of the upper knee circumference between the affected side and the healthy side was (5.02±2.29) cm, and after treatment the difference was (0.74±0.18) cm, and there was a statistically significant difference (t=7.601, P<0.001). There were no serious complications during thrombolysis. ConclusionsFor acute mixed-type LEDVT, transarterial CDT via iliac artery followed by popliteal vein PTA+PMT+CDT is safe and effective.