导管接触性溶栓治疗滤器置入后下腔静脉血栓形成  

Therapy of catheter-directed thrombolysis for inferior vena cava thrombosis after filter implantation

作　　者：雷锋锐[1] 李晓强[1] 钱爱民[1] 于小滨[1] 戎建杰[1] 桑宏飞[1] 孟庆友[1] 

机构地区：[1]苏州大学附属第二医院血管外科,215004

出　　处：《中华医学杂志》2014年第28期2197-2200,共4页National Medical Journal of China

摘　　要：目的 评估导管接触性溶栓（CDT）治疗滤器置入后下腔静脉血栓形成的疗效.方法 收集2009年6月至2012年6月苏州大学附属第二医院收治的滤器置入后下腔静脉血栓形成患者13例,累及26条肢体.经颈静脉置入可回收滤器,经一侧小隐静脉、股静脉或腘静脉入路行下腔静脉导管接触性溶栓,尿激酶用量60～100万U/d,经皮腔内血管成形术（PTA）及支架置入（stenting）开通闭塞下腔静脉.结果 11例患者经CDT后下腔静脉有效开通,平均置管溶栓时间为8.3d（7～13 d）,1例行下腔静脉PTA,1例行下腔静脉PTA＋ stenting,共置入可回收滤器4枚并成功回收,取出原有滤器3枚,26条受累肢体症状均缓解.所有患者均未出现严重并发症,随访期间未出现肺栓塞表现.结论 CDT治疗滤器置入后下腔静脉血栓形成疗效较好,安全性高.Objective To evaluate the efficacy and safety of catheter-directed thrombolysis （CDT） in treating with inferior vena cava （IVC） thrombosis after filter implantation.Methods A retrospective analysis of 13 patients with IVC thrombosis after filter implantation was conducted at our institution from June 2009 to June 2012.A total of 26 lower extremities were involved.IVC filters were implanted via right internal jugular vein.Then CDT was performed through small saphenous vein,popliteal vein or femoral vein.The dosage of urokinase was 0.6-1 million/day.The occlusive segment in IVC was managed with percutaneous transluminal angioplasty （PTA） and stenting.Results The obstructed IVC was re-opened after CDT in 11 cases.The average CDT time was 8.3 （7-13） days.PTA （n =2） and stenting （n =1） were performed.A total of 4 retrievable filters were planted and retrieved later successfully.No severe complications occurred.During the follow-ups,no clinically detetable sighs of pulmonary embolism were observed.Conclusion CDT is effective,safe and feasible in the treatment of IVC thrombosis after filter implantation.

关 键 词：下腔静脉 血栓形成 滤器 导管接触性溶栓 

分 类 号：R543.6[医药卫生—心血管疾病]