取栓联合腔内血管成形术治疗急性下肢深静脉血栓形成

目的 探讨开放手术结合多种介入方法对急性下肢深静脉血栓形成(deep venous thrombosis,DVT)的疗效.方法 本组521例(521条肢体),男356例,女165例.年龄16～86岁,平均(46±9)岁.均先经健侧安置下腔静脉滤器,再于患侧小切口解剖股静脉.行Fogarty导管取栓术.其中单纯取栓38例;取栓联合球囊导管血管成形术348例;血管成形联合血管腔内超声消融135例;支架置入108例.结果 手术成功511例,阻塞血管完全开通.其中除31例经造影未见血管狭窄,7例管腔直径＞90%而未行扩张治疗以外,365例狭窄段血管经球囊扩张后造影示静脉平均狭窄由90%±5%降低到24%±5%,108例狭窄段经扩张后残留管腔狭窄仍＞50%,置入相应大小裸支架;左髂总静脉开口未能开通10例.随访472例(90.6%),随访时间8～108个月,平均(53±26)个月.其中462例完全恢复正常或基本正常,可从事正常工作;10例髂静脉未开通者活动后肢体仍肿胀明显.发生并发症33例(6.3%).结论 取栓联合腔内血管成形术治疗DVT是一种安全、有效的方法.

Abstract：

Objective To evaluate a combination of open surgery and multiple interventional methods in the treatment of DVT of the lower extremities. Methods 521 cases (521 limbs,356 male and 165 female) were studied in this group. Age ranged from 16 to 86 years with the mean age of (46 ±9)years. All 521 cases with DVT were treated by Fogarty embolectomy catheter. Among them,348 cases underwent percutaneous transluminal angioplasty (PTA), 135 cases received PTA and ultrasound ablation,stent-grafts were implanted in 108 cases. Results Based on angiography during operation, the obstructed iliofemoral vein received complete recanalization in 511 cases. Among them, the postoperative luminal diameter was more than 90% in 38 cases after Fogarty embolectomy, the average stenosis rate was reduced from 90% ±5% to 24% ±5% in 365 cases after PTA and stent-grafts were implanted in 108 cases with the stenosis rate still over 50% after PTA. Only partial recanalization was achieved in the entrance of common iliac vein to inferior vena cava in 10 cases. Of the 521 cases,472 cases were followed-up with mean time of (53 ± 26) months, ranging from 8 to 108 months and 462 cases reported satisfactory results with normal life,the unsuccessful 10 cases still felt swelling pain especially in erect position. Complications occurred in 33 cases. Conclusions Open surgery combining with multiple interventional methods is a safe and effective method in the treatment of DVT.

Multidisciplinary transluminal intervention for the treatment of acute deep venous thrombosis of the lower extremities

Objective To evaluate a combination of open surgery and multiple interventional methods in the treatment of DVT of the lower extremities. Methods 521 cases (521 limbs,356 male and 165 female) were studied in this group. Age ranged from 16 to 86 years with the mean age of (46 ±9)years. All 521 cases with DVT were treated by Fogarty embolectomy catheter. Among them,348 cases underwent percutaneous transluminal angioplasty (PTA), 135 cases received PTA and ultrasound ablation,stent-grafts were implanted in 108 cases. Results Based on angiography during operation, the obstructed iliofemoral vein received complete recanalization in 511 cases. Among them, the postoperative luminal diameter was more than 90% in 38 cases after Fogarty embolectomy, the average stenosis rate was reduced from 90% ±5% to 24% ±5% in 365 cases after PTA and stent-grafts were implanted in 108 cases with the stenosis rate still over 50% after PTA. Only partial recanalization was achieved in the entrance of common iliac vein to inferior vena cava in 10 cases. Of the 521 cases,472 cases were followed-up with mean time of (53 ± 26) months, ranging from 8 to 108 months and 462 cases reported satisfactory results with normal life,the unsuccessful 10 cases still felt swelling pain especially in erect position. Complications occurred in 33 cases. Conclusions Open surgery combining with multiple interventional methods is a safe and effective method in the treatment of DVT.