滤器置入后症状性下腔静脉血栓形成的介入治疗  

The interventional therapy of symptomatic inferior vena cava thrombosis developed after filter implantation

作　　者：肖亮[1] 童家杰[1] 解世洋[1] 申景[1] 徐克[1] 

机构地区：[1]中国医科大学附属第一医院放射科,110001

出　　处：《介入放射学杂志》2011年第5期380-384,共5页Journal of Interventional Radiology

基　　金：国家十一五科技支撑计划资助项目(2007BAI05B04)

摘　　要：目的评估局部置管溶栓治疗滤器置入后症状性下腔静脉血栓形成的疗效和安全性。方法 2005年10月至2009年9月采用局部置管溶栓治疗滤器置入后症状性下腔静脉血栓形成患者4例,累及8条肢体。经右颈内静脉置入下腔静脉滤器后,采用导丝及导管开通闭塞的下腔静脉并置管溶栓治疗。血栓消融后分别经骨静脉或颈内静脉取出滤器。记录技术成功率和临床成功率、并发症、治疗后有无肺动脉栓塞。结果共置入4枚可回收式滤器、取出5枚滤器(包括原先置入的1枚)。4例下腔静脉开通及局部置管溶栓技术上均获成功;8条受累肢体临床症状均明显好转。滤器置入及取出操作的平均时间分别为2.0 min(1～3 min)和7.6 min(1～20 min)。平均置管溶栓时间11.8 d(8～14 d),取出的滤器体内平均留置时间40.4 d(14～73 d)。所有患者未出现严重的出血并发症,随访期间未出现明确肺动脉栓塞表现。结论管腔内开通及局部置管溶栓治疗滤器置入后症状性下腔静脉血栓形成疗效较好,安全性高,临床可予推广应用。Objective To evaluate the effect and safety of transcatheter thrombolysis in treating symptomatic inferior vena cava（IVC） thrombosis occurred after filter implantation in IVC.Methods During the period from October 2005 to September 2009,transcatheter thrombolysis was carried out in four patients with symptomatic IVC thrombosis which developed after filter implantation in IVC.A total of eight lower extremities were involved.IVC filter was implanted via right internal jugular vein,which was followed by recanalization of the occluded IVC with the help of guide wire and catheter,then,subsequent transcatheter intravenous thrombolysis was conducted.IVC filters were retrieved through femoral or right internal jugular vein after thrombus was sufficiently dissolved.Technical and clinical success rate,complications and the occurrence of postprocedural pulmonary embolism were observed and recorded.Results A total of four retrievable filters were implanted into IVC,and all the four filters together with a previously implanted filter were successfully retrieved.Both technical and clinical success of recanalization and thrombolysis were achieved in all four patients and eight symptomatic lower limbs.The mean time for filter implantation and retrieval operation was 2.0 minutes（in the range of 1-3 minutes） and 7.6 minutes（in the range of 1-20 minutes）,respectively.The average thrombolysis duration was 11.75 days（8-14 days）.The average filter-dwelling time was 40.4 days（range of 14-73 days）.No complications such as massive bleeding occurred.During clinical follow-up period,no clinically detectable signs of pulmonary embolism were observed.Conclusion For the treatment of symptomatic IVC thrombosis occurred after filter implantation in IVC,endovascular recanalization and transcatheter thrombolysis is effective,safe and feasible in clinical practice

关 键 词：血栓形成 滤器 下腔静脉 技巧 疗效 

分 类 号：R543.6[医药卫生—心血管疾病]